Higher Cigarette Taxes Tied to Fewer Infant Deaths
U.S. study suggests pregnant women may be less likely to smoke if tobacco prices are higher
By Randy Dotinga
TUESDAY, Dec. 1, 2015 (HealthDay News) -- A new study suggests that higher tobacco prices in the United States could save hundreds of infant lives every year by discouraging more women from smoking during and after pregnancy.
Specifically, researchers said that each $1 per pack increase in the overall tobacco tax rate over the years 1999-2010 may have contributed to two fewer infant deaths each day. The effect appears to be especially strong among black babies.
The research doesn't directly prove that higher taxes translate into fewer infant deaths. Still, "we found that increases in cigarette taxes and prices were associated with decreases in infant mortality," said study author Dr. Stephen Patrick, an assistant professor of pediatrics and health policy at Vanderbilt University in Nashville.
And it's clear, he said, that pregnant women who smoke put their unborn children at risk.
"Smoking in pregnancy can lead to poor outcomes like premature birth, the number one cause of death for infants in the first year of life," Patrick said. "As a neonatologist, I commonly see premature and low birth weight infants born to women who smoke, and we know that nearly one in five women smoke during pregnancy."
In the new study, researchers tracked infant death rates and tobacco taxes from 1999-2010, when inflation-adjusted tobacco taxes on the state and federal levels rose from 84 cents a pack to $2.37 per pack. During the same time period, the number of infant deaths per 1,000 live births fell from 7.3 to 6.2 overall, and from 14.3 to 11.3 among blacks.
After adjusting the statistics so they wouldn't be thrown off by high or low levels of women sharing characteristics like education level and income, the researchers estimate that each $1 per pack boost in cigarette taxes led to two fewer infant deaths per day, Patrick said. Overall, there was an estimated 3.2 percent decrease in annual infant mortality rates, or 750 fewer infant deaths per year, associated with the tax increase.
Apparently, the researchers believe, women smoke less when tobacco costs more.
Patrick acknowledged that it's possible that factors other than cigarette taxes contributed to the decline in the infant death rate. One possibility is that medical care improved over that time, leading to fewer deaths. But Patrick said that prospect is unlikely since such a change would presumably be seen in all states, and the study didn't reveal that kind of trend.
The researchers also examined the effect of tobacco prices, and found that increases appeared to have the same level of impact on infant mortality as tax hikes.
This is important since "there may not be political will to increase cigarette taxes in some states," Patrick said. "Tennessee recently increased the price of cigarettes in the state by increasing the profit margin for retailers and not through a tax. Our study suggests that this approach would be as effective as a tax increase."
David Levy, a professor of oncology at Georgetown University in Washington, D.C., said the research appears to be valid. The study doesn't need to confirm that higher taxes lead to lower smoking rates, he said, since other research has proven that to be the case, even among pregnant women.
What about the prospect that pregnant women and new mothers might choose to spend money on tobacco -- including higher taxes -- instead of on their children? "That would only occur if smoking is a large share of the household expenditures," Levy said. And, he said, it's important to note that research has shown that higher taxes are especially likely to lead to less smoking among the poor.
What's next? More research should be conducted in other countries, especially poorer countries that are trying to reduce deaths in infants, Levy said.
The study was published online Nov. 30 and will appear in the January issue of Pediatrics.
For more about tobacco use and pregnancy, try the U.S. Centers for Disease Control and Prevention.
SOURCES: Stephen Patrick, M.D., M.P.H., M.S., assistant professor, pediatrics and health policy, division of neonatology, Vanderbilt University, Nashville; David Levy, Ph.D., professor, oncology, Georgetown University, Washington, D.C.; January 2016, Pediatrics
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