If Rhode Island raises the cigarette tax, will smokers quit? Not really.
Purveyors of cheap tobacco and lottery tickets immediately fill the landscape: Vista Donuts, Lucky 95 Lottery and Smoke Shop, and Stateline Liquor & Smoke Shop. Before the pandemic, there was also a sex shop in this hamlet of vice. You’ve just crossed the state border on US-1 between Pawtucket and Attleboro, Massachusetts.
Gallivanting to Attleboro is the low-effort way for Rhode Islanders to evade the state’s cigarette tax. In Massachusetts, you’ll pay $3.51 in tax for a 20-pack of cigarettes. In Rhode Island, you’ll pay $4.25 for the same — the fourth highest cigarette tax in the nation, outpaced only by Connecticut ($4.35), Washington, D.C. ($4.50) and New York ($5.35).
The state’s rank would climb to second place under Gov. Dan McKee’s proposed budget for fiscal 2025. McKee is calling to raise the tax by another 25 cents, starting Sept. 1, 2024, a move that would squeeze out an extra $2.4 million in state revenue.
Taken at face value, such a proposal has the whiff of a public health initiative. But in his Jan. 16 State of the State address, McKee never mentioned his proposed cigarette tax increase nor a plan for the $2.4 million in additional revenue. The money will likely head for the general fund, but what if it were directed toward tobacco control efforts? That would be welcome news to Daniel Bower, executive director of the Rhode Island and Connecticut chapters of the American Lung Association (ALA).
Every 10% increase in cigarette prices lowers consumption by 4% in adult smokers and 7% in youth smokers, Bowler said. So a 25-cent increase in taxes is unlikely to move the needle when it comes to public health.
“If it’s just kind of nickel-and-diming it, we don’t see a real public impact,” Bowler said. “But if we do a big increase at one time — we recommend $1 — then that’s where we do see a real strong public health benefit.”
Bowler was more positive about McKee’s desire to impose order on the wild west of vape and e-cig sales, which are currently untaxed. The governor’s budget proposes an 80% wholesale tax starting Oct. 1, 2024, which would raise an estimated $5.3 million in vape revenue in fiscal 2025 and $6.4 million annually thereafter.
The fiscal 2025 budget also includes a $600,000 allotment for anti-vaping initiatives. $400,000 of that would go toward school-centric attempts to reduce vape use among young smokers. The other $200,000 would create two full-time positions in the Department of Revenue to oversee retail compliance for e-cigs. While this money technically comes from general revenue, its source of origin is actually the state’s 10-year, $6.2 million settlement with vape manufacturer Juul Labs from 2023.
Taxing both cigarettes and vaping products at the same time would hopefully inspire people to quit altogether, Bowler said.
“We would be seeing hopefully folks not jumping from one product to another, but really using that as an opportunity to hopefully sustain a quit from one of those products.”
All smokers aren’t created equally
Health department data from 2022 shows 11.8% of adult Rhode Islanders smoke cigarettes, and 6.7% use vapes. But smokers are a diverse population who differ in their ability to “say no.” There’s one category of cigarette smokers who might struggle to refuse: people with serious mental illness.
Smoking is observed at higher rates in populations with mental illness — 28.2% versus 15.8% of U.S. adults without mental health issues who smoke, according to data from the Center for Behavioral Health Statistics and Quality.
Smoking and schizophrenia in particular have long been recognized as tight bedfellows. Jennifer Tidey, an associate dean of research at Brown University, has studied the behavioral science of cigarette smoking in vulnerable populations. Tidey said the alleged smoking rates for people with schizophrenia are lower than when she entered the field in the 1980s. Eighty-five percent was one “inflated” number from decades past, Tidey said, but it’s probably more like 60% of people with schizophrenia who smoke.
“That’s still really high,” Tidey said.
A watered-down explanation of this relationship might chalk it all up to dopamine — a neurotransmitter heavily implicated in the biological actions of both nicotine and schizophrenia. Cigarettes have also been thought to mitigate harsh, physical side-effects from antipsychotic drugs taken for schizophrenia, or serve as relaxants in severe mental illness. But biology is only one part of the explanation, as Tidey will tell you. Social and environmental factors are important too, as is policy.
But is higher taxation the right policy?
“I don’t know that that’s necessarily the answer, because for some folks, that might not be a discouragement,” said Beth Lamarre, executive director of the Rhode Island chapter of the National Alliance on Mental Illness. “It’s only going to cause an additional stressor on their lives.”
Lamarre was once a smoker herself. “Quitting smoking is really hard to do, but it’s even harder to do when you’re struggling with the idea of, ‘Well, if I keep smoking, it’s gonna cost me some money, and I can’t afford it,’” she said. “And then the stress of that makes you want to continue smoking. That’s your coping mechanism. It’s sort of cyclical.”
While e-cigarettes aren’t exactly healthier, available research shows they are “less harmful than cigarettes,” Tidey said.
“And they help people quit smoking. So we have to be careful, and we’re going to increase the taxes on those products,” Tidey said.
“If it’s just we’re increasing taxes on cigarettes: Great. Fine. If we’re thinking also, ‘We’re going to increase taxes on vaping products,’ then I get a little worried about the relative prices of those products. If you make the cost of the vaping product higher, you might push people back towards cigarettes, especially if they find cigarettes more reinforcing.”
At least one group has started to rally against the possible vape tax. On Jan. 22, 2024, the Consumer Advocates for Smoke-free Alternatives Association (CASAA) posted a prewritten email in opposition to the proposed tax, which people then can send to their representatives.
I don't know that that's necessarily the answer, because for some folks, that might not be a discouragement. It's only going to cause an additional stressor on their lives.
Tobacco prevention woefully underfunded
The latest edition of the American Lung Association’s State of Tobacco Control was released on Jan. 24, and Bowler noted Rhode Island’s grades are “kind of all over the place.” Tobacco taxes and access to cessation services both received a B grade. Smokefree air got a C — largely because smoking is still allowed in the state’s casinos.
Rhode Island flunked in the prevention funding category. The CDC recommends Rhode Island spend about $12.8 million in tobacco prevention efforts — and even gave $1.4 million toward these efforts in fiscal 2023 — but the state itself only spent a little over $429,000.
Every year since 2020, cigarette taxes in Rhode Island have raked in over $120 million. In fiscal 2023, the state saw $133 million in tax revenue from cigarettes and other tobacco products combined. This fiscal year, which ends June 30, has seen nearly $57 million in cigarette tax revenue so far. Paul Grimaldi, the chief spokesperson for the state’s Department of Revenue, said this money goes into the state’s general fund.
Despite the state’s F grade, Bowler acknowledged the state Department of Health does good work “with what is really a shoestring budget.” In fiscal 2024, that shoestring is $429,205 worth of funds for the state’s Tobacco Control Program, confirmed Rhode Island Department of Health spokesperson Joseph Wendelken. Two of the state’s cessation initiatives are the Rhode Island Nicotine Helpline and My Life, My Quit, with the latter focused on providing an anonymous hotline for younger smokers.
The state has two agreements with the CDC. “One provides $5,313,123 over the period of June 29, 2020, to April 28, 2025, and funds us to operate as a state-level Tobacco Control Program. The other provides $1,875,000 over the period of Sept. 30, 2023, to Sept. 29, 2028, for menthol-specific work,” Wendelken said in an email.
Tidey wonders if prevention might start before cigarettes even leave the factory. What if cigarettes were simply manufactured with less nicotine? It’s a regulatory change that would need federal backing, but it’s also a prevention measure Tidey’s research has found promising.
A 2016 research article Tidey co-authored noted that low-nicotine cigs didn’t increase smoking intensity among smokers with schizophrenia. The study sought to determine if smokers with schizophrenia “may alter their puffing in an attempt to extract more nicotine” from the weaker cigarettes. But “total puffs and total cigarette volume were reduced” even in this hard-to-treat population.
Lamarre, meanwhile, thinks support groups for smoking cessation — à la Alcoholics Anonymous, but for cigarettes — can offer the necessary support and impetus to quit with a non-drug approach. Nicotine patches, gum or medications like varenicline, sold as Chantix, are widely known, but socially oriented treatments may not be on people’s radars.
“The resources are probably more available than people think, and no, I don’t think people necessarily know that those resources are available,” Lamarre said.
Taxes aren’t the only thing to affect cigarette prices. Retail costs can also be impacted by bans on discounts or coupons, which manufacturers can use to encourage sales by circumventing higher taxes. Providence, for example, banned discounts in 2012.
Massachusetts doesn’t allow manufacturer discounts either, and overall the commonwealth’s cigs aren’t much cheaper in retail than those in than Rhode Island. Smokers with a little more wanderlust can find even better deals.
“If you want to take a good drive, you could go two hours to New Hampshire where prices are like one-third of what they are in Rhode Island,” Lamarre said. “There are a lot of things that people — especially if you use smoking as a coping mechanism — that you’ll know and do and learn from other people.”
The frugal smoker might squirrel cartons they buy in bulk elsewhere. They can also roll their own cigarettes, although Rhode Island is notorious among smokers of both tobacco and cannabis for its high prices on rolling papers, which are taxed as if they were cigarettes.
Whatever the tactic, love finds a way — or at least compulsion does. When Richard Klein, a professor of French literature at Cornell University, tried to quit smoking in the early 1990s, he ended up with a 232-page cultural history of cigarettes. With all the bittersweet regret of a lover looking back on something lost, Klein wrote of cigarettes as a complicated pleasure with a “certain philosophical dignity.”
Klein had quit smoking by the time he finished writing “Cigarettes Are Sublime.” But his book hints at why some people keep smoking beyond apparent reason: “Taken as an object of reflection, cigarettes invite the return of the same, like smoke rings circling round before vanishing.”
The same comfortable warmth, over and over and over again? For some smokers, an extra quarter in tax is a small price to pay for that peace of mind.