Cigarette tax and price increases are particularly effective in reducing the number of pregnant women who smoke. Because maternal smoking is a preventable cause of low birth weight, sudden infant death syndrome, ectopic pregnancy, spontaneous abortion, and neonatal mortality, the resulting reductions in smoking reduce these health complications and should result in health care cost savings (Evans and Ringel, 1999; Ringel and Evans, 2001; Colman et al., 2003).
Efforts to reduce smoking among pregnant women gained urgency with the release of the 2001 Surgeon Generals report on smoking among women (DHHS, 2001). The report concluded that smoking during pregnancy causes numerous complications, including increased risks for ectopic pregnancy, spontaneous abortion, premature rupture of membranes, separation of the placenta from the uterus, abnormal location of the placenta, and premature delivery. These complications can result in stillbirth, or place the babies at greater risk of dying, either at birth, or in the months that follow.
Multiple studies conclude that increases in cigarette taxes and prices result in significant reductions in the prevalence of smoking among pregnant women. The following are among some of the findings:
- A 10 percent increase in cigarette prices would reduce pregnant womens smoking prevalence by about 5 percent (Evans and Ringel 1999, using data from the 1989 through 1992 Natality Detail files).
- A 10 percent price increase would reduce prevalence of smoking among pregnant women by up to 7 percent, in nearly all subgroups of the population of pregnant women, including those defined by marital status, race/ethnicity, age, and those with relatively high smoking rates; the researchers also found that nearly all subgroups are more responsive to price than the general adult population (Ringel and Evans, 2001, updating their analysis using data through 1995).
- A 55-cent increase in cigarette excise taxes would have reduced maternal smoking prevalence by about 22 percent (Ringel and Evans, 2001).
- A 10 percent increase in cigarette taxes increases the probability of a woman quitting smoking during pregnancy by 10 percent (Colman et al., 2003, using data from the Pregnancy Risk Assessment Monitoring System in 10 states from 1993 through 1999).
Given the health consequences of smoking during pregnancy, tax- and price-induced reductions in maternal smoking can significantly improve birth outcomes. Evans and Ringel (1999), for example, show that higher cigarette taxes lead to increases in average birth weight. They estimate that a $1.10 tax increase that would have reduced smoking prevalence among pregnant women by 32 percent would also have reduced the probability of a low birth weight birth by 5 percent.