The Real Cost of Smoking by State feat. Dr. Fridberg

Adam McCann, Financial Writer  •  Jan 15, 2020

https://wallethub.com/edu/the-financial-cost-of-smoking-by-state/9520/#expert=daniel-fridberg

Smoking doesn’t just ruin your health. It can also burn a nasty hole through your wallet. Tobacco use accounts for nearly half a million deaths in the U.S. each year and is the leading cause of lung cancer, according to the American Lung Association. Even those around tobacco smokers aren’t safe from its harmful effects. Since 1964, smoking-related illnesses have claimed over 20 million lives in the U.S., 2.5 million of which belonged to nonsmokers who developed diseases merely from secondhand-smoke exposure.

However, the economic and societal costs of smoking are just as huge. Every year, smoking costs the U.S. more than $300 billion, which includes both medical care and lost productivity. Unfortunately, some people will have to pay more depending on the state in which they live.

To encourage the estimated 34.2 million tobacco users in the U.S. to kick the dangerous habit, WalletHub looked into the true per-person cost of smoking in each of the 50 states and the District of Columbia. We calculated the potential monetary losses — including both the lifetime and annual cost of a cigarette pack per day, health care expenditures, income losses and other costs — brought on by smoking and exposure to secondhand smoke. Read on for the complete ranking and analysis, insight from a panel of experts and a full description of our methodology.

1COSTS OVER A LIFETIME2COSTS PER YEAR

3ASK THE EXPERTS4METHODOLOGY

 

Costs Over a Lifetime

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The Real Cost of Smoking by State

*1=Least Costly

 

Costs per Year

*1=Least Costly

 

Ask the Experts

Many studies show that smoking can have significant negative physical and financial effects. To advance the discussion, we asked a panel of experts to share their insight regarding smoking-cessation programs, e-cigarettes and other smoking-related concerns. Click on the experts’ profiles to read their bios and responses to the following key questions:

1. What are the most effective strategies for people trying to quit smoking? What approaches typically fail?
2. Should e-cigarettes be regulated and taxed as cigarettes or as medical devices?
3. How might marijuana legalization affect tobacco use?
4. How can state and local authorities encourage people to quit smoking? Is there a role for employers? Health insurance companies?

Back to All Experts

Daniel Fridberg

Assistant Professor of Psychiatry and Behavioral Neuroscience, University of Chicago

What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail?

The most effective strategies for quitting are a combination of behavioral counseling and FDA-approved stop-smoking medications. Counseling is effective for helping smokers to learn ways to manage cravings to smoke and develop new habits to become smoke-free. Stop smoking medications, which include over-the-counter nicotine replacement therapies (like the nicotine patch, gum, or lozenge) and prescription medications (like bupropion [Welbutrin] and varenicline [Chantix]) have been shown in numerous studies to be safe and effective and can significantly increase a smoker’s chances of quitting for good.

Should e-cigarettes be regulated and taxed as cigarettes or as medical devices?

A decision on how to classify e-cigarettes would ultimately be up to the FDA. Right now e-cigarettes are regulated as “tobacco products” by the FDA, along with cigarettes, cigars, etc. In light of this, some jurisdictions have implemented, or are proposing to implement, taxes on e-cigarettes. So far, 17 states and Washington D.C. have established taxes on e-cigarette products.

How might marijuana legalization affect tobacco use?

In adults, nationwide studies have shown a strong association between cannabis and tobacco use, with 70% or more of past-month cannabis users reporting using tobacco during the same period. There is some evidence that cannabis use predicts the onset of smoking. This makes sense, as combining cannabis and tobacco is a popular way to use both products, such as in “blunts” or “spliffs”. Co-users of cannabis and tobacco tend to have higher rates of nicotine dependence (i.e., tobacco addiction) than those who use tobacco only. As the legal landscape around cannabis is shifting rapidly, more research is needed to examine the downstream effects on public health.

How can state and local authorities encourage people to quit smoking? Is there a role for employers? Health insurance companies?

Taxes and smoking bans proved to be particularly effective ways to reduce smoking rates. Outside of those policy issues, providing citizens with access to free- or low-cost resources to quit smoking, such as tobacco quitlines and nicotine patches, also help. Employers and insurance companies can help by incentivizing smokers to quit; for instance, by charging lower premiums for those who quit successfully and by providing access to evidence-based stop-smoking resources, such as medication and counseling.

 

Methodology

In order to assess the impact of tobacco use on a smoker’s finances both over a lifetime and in a single year, WalletHub calculated the potential monetary losses — including the cumulative cost of a cigarette pack per day over several decades, health-care expenditures, income losses and other costs — brought on by smoking and exposure to secondhand smoke.

For our calculations, we assumed an adult who smokes one pack of cigarettes per day beginning at age 18, when a person can legally purchase tobacco products in the U.S. We also assumed a lifespan of 51 more years, taking into account that 69 is the average age at which a smoker dies.

Out-of-Pocket Costs

To determine per-person Out-of-Pocket Costs Over a Lifetime, we took the average cost of a pack of cigarettes in each state and multiplied that figure by the total number of days in 51 years. For Costs per Year, we multiplied the average cost by 365 days.

Financial Opportunity Cost

To determine the per-person Financial Opportunity Cost, we calculated the amount of return a person would have earned by instead investing that money in the stock market over the same period. We used the historical average market return rate for the S&P 500 minus the inflation rate during the same time period to reflect the return in present-value terms.

Health-Care Cost per Smoker

Direct medical costs to treat smoking-connected health complications are one of the biggest financial drains caused by tobacco use. To calculate related health-care costs, we obtained state-level data from the Centers for Disease Control and Prevention — namely the annual health care costs caused by smoking — and divided that amount by the total number of adult smokers in each state.

Income Loss per Smoker

Previous studies have shown that smoking can lead to loss of income, either because of absenteeism, workplace bias or lower productivity due to smoking-related health problems. This can create a wage gap between smokers and nonsmokers. To represent the negative relationship between earnings and smoking, we assumed an average 8 percent decrease in the median household income for each state. We arrived at this figure after a recent study from the Federal Reserve Bank of Atlanta found that smokers earn 20 percent less than nonsmokers, 8 percent of which is attributed to smoking and 12 percent to other factors.

Other Costs per Smoker

Nonsmokers are generally entitled to a homeowner’s insurance credit of between 5 and 15 percent, according to the Independent Insurance Agents & Brokers of America. Given that fact, we assumed an 11.1 percent increase (i.e. the inverse of a 10 percent credit, or the average between the two percentages) in the average homeowner’s insurance premium for each state to represent the penalty cost for smokers.

We then took into account the costs for victims of secondhand-smoke exposure. To calculate these costs, we used the per-nonsmoker expenditure in the state of New York as a proxy. We then multiplied that figure by the number of nonsmokers in each state to obtain the total costs of exposure to secondhand smoke at the state level. Finally, we divided the resulting total by the number of smokers in each state. This approach assumes that, in a perfect society, smokers would also pay the costs related to the harmful smoke that tobacco releases into the air.

Formula for Financial Cost of Smoking

Financial Cost of Smoking = Out-of-Pocket Costs + Financial Opportunity Cost + Related Health-Care Costs + Income Loss Due to Smoking-Related Issues + Increase in Homeowner's Insurance Premium + Secondhand Smoke-Exposure Costs.

 
Sources: Data used to create this ranking were collected from the U.S. Census Bureau, Centers for Disease Control and Prevention, Insurance Information Institute, Campaign for Tobacco-Free Kids and NYsmokefree.com.

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