Tobacco Tax Initiative -- Oregon, 1996

In 1995, tobacco use contributed to the deaths of 6274 persons in Oregon (1995 population: 3,132,000) as reported by physicians on death certificates; annual costs in Oregon for the direct and indirect consequences of tobacco use were approximately $1 billion (State Health Division, Oregon Department of Human Resources, unpublished data, 1997). In response to the health burden associated with tobacco use in Oregon, in late 1995 a statewide coalition of health-care and tobacco-use prevention interests began a petition-driven citizen initiative, "Measure 44," to increase the tax on each pack of cigarettes from 38[ to 68[ and the tax on noncigarette tobacco products from 35% to 65% of wholesale price beginning February 1, 1997. This report presents findings of surveys conducted before and after the measure was approved by voters; in both surveys, respondents indicated that support for such an initiative was increased by dedicating a portion of the new revenue to tobacco-use prevention and education and to expanded insurance coverage under the Oregon Health Plan (OHP) for medically underserved persons.

The measure presented to voters on November 5, 1996, authorized 10% of the new tobacco tax revenue to be used to develop and implement statewide tobacco-use prevention and education programs managed by the State Health Division, Oregon Department of Human Resources, and 90% to be used to expand health-care coverage under the OHP. The initiative was approved by 56% to 44%. The coalition of health-care and tobacco-use prevention interests reported spending $650,000 to promote the initiative, compared with $4.8 million spent almost exclusively by the tobacco industry to oppose the initiative (1). Voter turnout was 71%, similar to turnouts in previous presidential election years; 97% of those voting cast a vote on this issue.

Pre-Election Survey

From September 18 through October 11, 1994, a population-based, random-digit-dialed telephone survey of persons aged greater than or equal to 18 years in Oregon was conducted on tobacco excise tax policies (2). Respondents were asked about increasing the state tobacco excise tax with the revenue to be used to help pay for 1) a greater share of the OHP, 2) programs to reduce or prevent smoking, 3) other health programs in addition to those aimed at reducing or preventing cigarette smoking, and 4) any government purpose, not just health, health insurance, or smoking prevention. Respondents were asked whether they currently smoke every day or some days and whether they use pipes or cigars, chew tobacco, or use snuff regularly. Persons who currently used any tobacco product were classified as "tobacco users." Of the 1538 telephone numbers in the sample, 813 households were contacted; one person aged greater than or equal to 18 years was randomly selected in each household for interview. A total of 631 sampled telephone numbers were excluded because they were not residences or were not in service; residential status could not be determined for 94. Completed surveys were obtained from 594 (73%) households.

Overall, 68% (95% confidence interval {CI}=plus or minus 4.0%) of respondents favored an increase in tobacco taxes, including 76% (95% CI=plus or minus 4.5%) of respondents who reported no current tobacco use and 44% (95% CI=plus or minus 8.5%) of respondents who reported current tobacco use. However, 89% (95% CI=plus or minus 2.6%) of respondents favored an increase if the funds were used for the OHP; 67% (95% CI=plus or minus 4.0%), if the funds were used for tobacco-use prevention; 67%, if the funds were used for other health programs; and 20% (95% CI=plus or minus 3.5%), if the funds were added to state general funds.

Post-Election Survey

A 1996 post-election survey of Oregon households was conducted by the Program for Governmental Research and Education of Oregon State University to assess reasons respondents voted on items on the ballot, including Measure 44 (3). A sample of 1800 addresses were randomly selected from telephone directory listings that included current mailing addresses of all Oregon households with telephones. In the initial mailing, 430 addresses identified as invalid were excluded from the sample. Households that did not reply by mail were contacted by telephone. Completed surveys were obtained from 699 (51%) of 1370 households.

Overall, 61% (95% CI=plus or minus 3.6%) of respondents reported voting for the measure, and 38% (95% CI=plus or minus 3.6%) reported voting against it. Reasons cited by voters who supported the initiative were consistent with goals promoted by the coalition supporting the initiative: the primary reason for 66% (95% CI=plus or minus 4.5%) was "to discourage tobacco consumption," and for 27% (95% CI=plus or minus 4.2%), "to expand the health plan." Of respondents voting against the initiative, 47% (95% CI=plus or minus 5.9%) reported that the primary reason was "tobacco users should not be forced to pay a disproportionate share of health costs," and 36% (95% CI=plus or minus 5.7%) reported that it would "lead to wasteful spending by the government"; both issues were emphasized in the "No on 44" campaign (3).

Reported by: W Bjornson, MPH, Oregon SmokeLess States Project, Portland; RC Sahr, PhD, Oregon State Univ, Corvallis; J Moore, PhD, H Balshem, MA, D Fleming, MD, State Epidemiologist, State Health Div, Oregon Dept of Human Resources. R Strouse, PhD, J Hall, MA, Mathematica Policy Research Inc., Princeton, New Jersey. BS Steel, PhD, Washington State Univ at Vancouver. Epidemiology Br, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report suggest that, in Oregon, support for the increase in tobacco excise taxes was increased by explicit dedication of new revenue from the tax for both a new statewide tobacco-use prevention and education program and expanded insurance coverage under the OHP. Oregon is the fourth state since 1988 to pass a citizen initiative to raise tobacco taxes and dedicate a portion of the new tax revenue to prevention and education programs; others were California (in 1988), Massachusetts (1992), and Arizona (1994). Similar initiatives failed in Montana (1990) and Colorado (1992). Michigan passed a citizen initiative to increase the tobacco excise tax from 25[ to 50[ in March 1994 as part of a multifaceted ballot initiative to replace property tax funding of schools with other taxes. In 34 other states since 1988, legislatures have increased tobacco excise taxes (e.g., Washington {from 56.5[ to 81.5[ in 1994}) (4). Data from the surveys described in this report suggest that a desire to reduce tobacco use was prevalent among adults before the election and was a primary factor considered by voters. As in other states (e.g., Michigan), the dedication of funds to a public service objective (e.g., expanding the OHP) was viewed positively (5).

Although increasing excise taxes on cigarettes has been suggested as one of the most cost-effective short-term strategies to reduce tobacco consumption among adults and prevent youth initiation of tobacco use (6), a tax increase combined with an antismoking campaign can be more effective in sustaining the reduction in per capita consumption than a tax increase alone (7). With the implementation of a statewide program, both California and Massachusetts have sustained greater declines in per capita tobacco use than the rest of the nation; from 1992 through 1996, per capita consumption declined 19.7% in Massachusetts and 15.8% in California but only 6.1% in the remaining 48 states and the District of Columbia combined (7). Although youth smoking rates have increased in both states, recent analyses suggest that the rates would have increased more rapidly in the absence of the excise tax increases and tobacco-control programs (8).

The State Health Division, with technical assistance from CDC, is developing and implementing a comprehensive tobacco-use prevention and education program incorporating components that have been effective in past research and other statewide demonstration efforts. Based on projections for 1997-1998, the program will receive approximately $17 million per biennium. The funds raised through this tax initiative will be used for 1) active community coalitions coordinated through local health departments; 2) prevention programs targeted toward youths that incorporate comprehensive school-based programs linked to community efforts; 3) public education through paid advertising and promotional activities; 4) cessation services for adults and youths that are integrated into the existing health-care delivery systems; 5) grants for special populations, a quitter's hotline, and innovative programs and training; and 6) an evaluation system to measure program effectiveness.

References

1. Election Division, Oregon Secretary of State. Summary statement of contributions and expenditures. Portland, Oregon: State of Oregon, 1996.

2. Mathematica Policy Research Inc. SmokeLess States Tobacco Control Survey. Portland, Oregon: Tobacco-Free Coalition of Oregon, 1994.

3. Sahr RC, Steel BS, Sellers SW. Results of the 1996-97 Oregon Fiscal Choices Survey. Corvallis, Oregon: Program for Governmental Research and Education, Oregon State University, April 1997 (in press).

4. The Tobacco Institute. The tax burden on tobacco. Vol 30. Washington, DC: The Tobacco Institute, 1995.

5. Public Opinion Research Institute. Cigarette taxes and the 1992 state elections: the public voices its desire for new faces in the legislature and its support for an increase in the cigarette tax. Lansing, Michigan: Public Sector Consultants/American Lung Association-Michigan, 1992.

6. National Cancer Institute. The impact of cigarette excise taxes on smoking among children and adults. Washington, DC: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, 1993.

7. CDC. Cigarette smoking before and after an excise tax increase and an antismoking campaign -- Massachusetts, 1990-1996. MMWR 1996;45:966-70.

8. Chaloupka FJ, Grossman M. Price, tobacco control policies, and youth smoking. Cambridge, Massachusetts: National Bureau of Economic Research, September 1996 (National Bureau of Economic Research Working Paper Series, no. 5740).

   
   

+------------------------------------------------------------------- -----+ | Erratum: Vol. 46, No. 11 | | ======================== | | SOURCE: MMWR 46(12);271 DATE: Mar 28, 1997 | |             | | In the article "Tobacco Tax Initiative -- Oregon, 1996," on page | | 247, in the third sentence of the first paragraph of the Editorial | | Note, a date was given incorrectly. The sentence should read, | | "Similar initiatives failed in Montana (1990) and Colorado (1994). | +------------------------------------------------------------------- -----+

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