Tobacco Tax Improves Dental Health of Nonsmokers

Tobacco taxes reduce the likelihood of smoking. This improves the health of smokers and nonsmokers alike.

All 50 states and Washington, DC impose a cigarette excise tax that ultimately gets passed on to the consumer through the price of cigarettes.  A recent study investigates whether the state cigarette excise tax is associated with health. The authors chose second hand smoke (SHS) exposure and periodontitis as markers.  The authors hypothesized that (1) states with historically high cigarette excise taxes would have lower per capita cigarette sales and (2) nonsmokers in those states would have less SHS exposure and lower odds of periodontitis than did nonsmokers in states with historically low tax levels.

Overall, 40.5% of nonsmokers were exposed to SHS according to serum cotinine concentrations (a biomarker for nicotine). Men had statistically higher proportions of SHS exposure than women (46.4% vs. 37.0%).  Adults aged 20 to 49 years were statistically more likely to be exposed than were older adults.  Higher education was significantly associated with a lower amount of SHS exposure and lower per capita cigarette sales.

For each additional pack of cigarettes sold per person per month, the adjusted odds ratio of being exposed to SHS increased by 28% (OR=1.28; 95% CI= 1.17, 1.40), and the odds of periodontitis increased by 15% (OR=1.15; 95% CI= 1.03, 1.29).

Those with SHS exposure had a more than 2-fold increase in risk for periodontitis (OR=2.03, 95% CI= 1.30, 3.20).  Higher cigarette excise tax was protective of periodontal health with a 22% reduction in the odds for periodontitis for each additional $0.10 in excise tax (95% CI= 0.61,0.97).

Cigarette excise tax alone was not statistically significantly associated with SHS exposure.

Commentary

This article assesses the epitome of public health policies that attempt to tie our economic structure to our health outcomes through legislation.  The influence of taxes on our health behaviors has consistently been questioned as to their effectiveness. Here the authors take a unique approach to assessing outcomes other than direct poor lifestyle choices.

Of course, we know that cigarette smoking worsens health outcomes for the individuals who choose to perform that activity. It contributes to heart attacks, strokes, chronic obstructive pulmonary disease, and cancer.  The idea that an individual’s use of cigarettes may influence not only his or her health but also influence other individual’s morbidity and mortality provides a broader perspective on our approach to public policy. The externalities of cigarette smoking are large and impact the health of nonsmokers. Research must consider these larger yet indirect effects that unhealthy behaviors have on our nation’s health.

Sanders, A. and Slade, G. AJPH. 2012; online ahead of print.

by

Kameron Matthews, MD, JD