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HIGHEST RATE OF SMOKING AMONG 10 BIGGEST U.S. CITIES: PHILADELPHIA

But Could Cigarette Taxation Change That?

When it comes to smoking, Philadelphia is an anomaly. While the national smoking rate has been falling consistently since the 1960s, it has fallen the least here. Today, Philadelphia has the highest
Philadelphia smoking
Philadelphia has the highest rate of smoking of America's 10 largest cities. It is also the poorest of those ten metro areas.
smoking rate among the ten largest cities in the U.S. at 25% of the adult population. According to the Philadelphia Department of Health, the use of tobacco products is the cause of 2,000 preventable deaths annually.

Cigarette tax debate
Those unfortunate facts provided the background against which Penn's Center for Public Health Initiatives (CPHI) recently organized a debate about whether or not taxation should be used to deter unhealthy behaviors like smoking.

In Philadelphia, 60% of tobacco retailers sell cigarettes at less than $5 a pack -- in stark contrast to New York City, where a state-level tax of $4.35 per pack keeps prices at nearly $15 a pack.

Arguing in favor of a tobacco tax structure that supports a New York-like strategy was Dr. Giridhar Mallya, Policy and Planning Director for the Philadelphia Department of Public Health and an LDI Senior Fellow. On the other side of the CPHI debate was Dr. Don Kenkel, an economics professor at Cornell University who questioned whether taxes were the most effective means of changing smoking behavior. Dr. Kenkel cited a lack of research that adequately controls for other variables, like changes in the market and demographic trends. He is also unconvinced that taxes of a dollar or two have much bearing on consumer incentives.

smoke chart 1

The idea of using a tax to deter smoking is not a new one here; a proposed law that would implement such a tax has been a political football in Philadelphia for years and continues to face roadblocks despite local support. The city council approved a $2-per-pack tax back in 2011, the revenues from which would fund Philadelphia schools, but implementation has so far been blocked at the state level.

Effect of $2-a-pack tax
A study conducted by Dr. Mark Stehr, a professor of business at Drexel University, estimated that adoption of the $2-per-pack tax would lead to 8,000 fewer adult smokers and $15 million in annual health care savings. A number of studies have established that cigarette taxes are effective at decreasing smoking among youths, and could prove a useful tool to combat the growing numbers of young smokers. In its own analysis, the Congressional Budget Office determined that a 10% increase in cigarette prices would motivate people under age 18 to reduce their smoking by 5-15%, and people over 18, by 3-7%.

Perhaps the group most affected by cigarette taxes is low-income consumers. While some criticize these taxes for being regressive, the flip side is that low-income groups have the most to gain from them, in terms of the health and financial benefits of quitting smoking.

Smoking rates and income
Smoking rates are linked closely to income and the rate of Philadelphians living below the poverty line has been increasing. Philadelphia is now the poorest of the ten largest cities in the U.S. In some communities within the city, as many as 40% of adults smoke. Youth smoking also appears to be on the rise in Philadelphia: the city has the highest rates of regular youth smoking in the country.

smoking chart 2

Numbers from the Department of Public Health show that tobacco is more readily available to underage smokers in Philadelphia than in any other city, with 1/3 of underage smokers buying their own cigarettes.

Big Tobacco targets minority communities
Advertisers exacerbate this by targeting minority and low-income communities in which smoking is already more prevalent than average. A study by the Philadelphia Department of Public Health and the University of Pennsylvania School of Design released in early August documented that there are more than 4,600 corner stores, gas stations and convenience stores licensed to sell tobacco products in Philadelphia. Those in low-income neighborhoods are more likely to plaster their exterior windows and walls with large and colorful cigarette advertisements. The researchers, led by LDI Senior Fellow Amy Hillier, found that those same establishments were also more likely to illegally place free-standing cigarette ads along the sidewalks as well as illegally hang tobacco ads from street signs and utility poles. This overall environment in low-income neighborhoods, the study said, "increases smoking initiation among adolescents, undermines smokers' quit attempts and promotes relapse among former smokers."

The bottom line -- of the CPHI debate as well as the reality on the ground in Philadelphia -- seems to be that the cigarette tax battle will continue to play out in Harrisburg, but for the time being the Department of Public Health will have to look to other methods of promoting smoking cessation.

While educational efforts over the past five years have shown some positive changes, Dr. Giridhar Mallya pointed out that an 85% cut in funding for tobacco control efforts in Philadelphia is not likely to make the battle against tobacco addiction any easier.

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Lauren Reed-Guy is a University of Pennsylvania senior majoring in English and a free-lance writer.

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