Why other cities should not adopt St. Paul’s tobacco policy

Tomorrow, the St. Paul City Council is poised to pass one of the most restrictive tobacco ordinances in the state. Among other things, the ordinance establishes a $10 minimum price on cigarettes and does not allow the use of coupons or discounts on cigarettes and other tobacco products including vaping products.

Cigarettes being harmful is something that has never been under dispute, but a Star Tribune editorial piece urging other cities to follow in St. Paul’s footsteps gets a few things wrong.

Cigarette smoking has been going down, and a big part of that is due to public awareness of the harms of smoking. Contrary to what the editorial states, prices are not the single most effective deterrent to smoking. Smoking –– especially regular and long-term –– is much more common among disadvantaged groups like people with poor mental health who are unlikely to respond to price changes.

According to the National Institute on Drug Abuse, “People with mental illness smoke at two-to-four times the rate of the general population.” The Minnesota Department of Health estimated that in 2016, for example, the smoking rate among people with mental illness was 30 percent. The smoking rate among the general population is, however, a little less than half of that –– 14.5 percent.

Smoking rates are, furthermore, highest among individuals with compounding socioeconomic conditions like poverty and low education. In 2016, among individuals with household incomes less than $35,000, those with a high school education or less, and those on Medicaid, smoking rates were higher than 20 percent.  

However, among people with household incomes higher than $75,000, the smoking rate is less than 10 percent. In fact, in 2019, 50 percent of smokers in Minnesota made less than $25,0000. So, hiking prices will only mean that these individuals will have to cough up more of their income on tobacco products, with no significant impact on rates of use.  This is a regressive tax on smokers; no other way around that.

Generally, higher-income individuals respond better to price hikes compared to low-income individuals –– who unfortunately make up most regular and long-term smokers. Take, for instance, what happened in Minnesota between 1995 and 2019. During this period, the state has had four tobacco tax hikes. Despite that fact, the smoking rate for individuals with incomes of $24,999 or less has remained stable, and among individuals with incomes less than $15,000 the smoking rate has increased. In contrast, among individuals earning $50,000 or more, the smoking rate has fallen from 16.1 percent to 10.5 percent.

And while the youth can be said to be more sensitive to prices, recent research has shown that they are becoming less sensitive to tobacco taxes, which should put a damper on the idea that price hikes will have a huge impact on youth smoking rates. This especially considering that smoking among the youth is largely a factor of social surroundings. According to the MDH, “Students who use tobacco are twice as likely as non-users to live with someone who also uses tobacco.” Price hikes are therefore not the magic bullet to tobacco use that lawmakers proclaim them to be.

It is especially contradictory that the City Council aims to reduce the harm caused by smoking while also raising the cost of less harmful tobacco products — like e-cigarettes, which have been known to help smokers quit. The FDA asserts that nicotine, while addictive, is not necessarily a harmful product. Instead, it is the mix of thousands of chemicals contained in cigarettes –– not nicotine –– that causes serious cardiovascular and respiratory diseases as well as other health risks. E-cigarettes and other non-combustible tobacco products have a mechanism to deliver nicotine to individuals without adding in harmful chemicals and are therefore a better substitute to tobacco products.

Treating these less harmful tobacco products like cigarettes will only push more people –– especially the youth –– into smoking cigarettes as data has shown. Evidence from other cities like San Francisco show that restricting the use of vaping products among the youth increases smoking rates –– which is way more harmful to public health.

If the goal is to indeed reduce the harm caused by cigarettes and other harmful tobacco products, improving access to less harmful products like e-cigarettes could offer a solution. Even the FDA recognizes the role that non-combustible cigarette products can play in reducing the harm caused by cigarettes. Price hikes and taxes will only bury poor smokers under heavy expenses while doing very little for tobacco use rates.