Americans drink less when cigarettes cost more

In the U.S., higher cigarette taxes and strict smoke-free policies not only curb smoking but also lower alcohol consumption, a new study shows.

Psychiatry researchers Melissa Krauss (left) and Richard Grucza, PhD, analyzed data from all 50 states and found that higher cigarette taxes and policies prohibiting smoking in public places are associated with a decrease in per capita alcohol consumption. (Credit: Robert Boston)

On a national level, the effect is relatively modest. Researchers at Washington University School of Medicine in St. Louis found that a 10 percent increase in the price of cigarettes leads to a 1 percent decrease in per capita alcohol consumption. But states with the highest prices and most restrictive anti-smoking policies, such as New York and Illinois, saw the greatest declines in alcohol consumption.

The study is published online in the October 2014 issue of Alcoholism: Clinical & Experimental Research.

Smoking and drinking often go together. Smokers are more likely than nonsmokers to drink alcohol, and heavy smokers are more likely to be heavy drinkers. But while raising cigarette taxes and implementing smoking bans are known to deter smoking, it hasn’t been clear how such policies affect alcohol use.

“One of the implications here is that reduced drinking may be yet another health benefit related to tobacco-control policies,” said co-investigator Richard A. Grucza, PhD, associate professor of psychiatry. “It appears that one way to control alcohol consumption is to target tobacco.”

The researchers analyzed changes in cigarette prices and public smoking policies from 1980-2009 and looked at per capita alcohol consumption during that same time period.

“In the last two decades, smoking rates dropped among young people and adults in the U.S., at least partly in response to rising prices and stricter smoke-free air policies,” said first author Melissa J. Krauss, a senior statistical data analyst in the Department of Psychiatry.

Americans consume an average of 2.28 gallons of pure alcohol per person each year. That’s the equivalent of about 486 12-ounce bottles of beer, 5-ounce glasses of wine or 1.5-ounce shots of hard liquor. A standard beer is about 5 percent alcohol, while most wine is about 12 percent and spirits such as bourbon or vodka are about 40 percent alcohol.

Many states increased taxes on cigarettes during the study period, but some raised rates more than others. For example, the average price of a pack of cigarettes rose from $1.91 to $8.54 in New York and from $1.80 to $6.35 in Illinois. Meanwhile, in North Carolina and Kentucky the prices per pack went up from about $1.39 to just more than $4.80, and the price per pack in Missouri increased from $1.76 to $4.35.

In addition, evaluating public smoking bans on a six-point scale, the researchers found that states such as New York and Illinois implemented very strict bans, with scores of 6. Missouri banned smoking in some places and earned a score of 3.41, while states such as North Carolina and Kentucky ended the study period with smoke-free air scores of zero, meaning they had implemented very few smoking bans in public places.

Krauss, Grucza and their colleagues found that per capita alcohol consumption fell in New York from 2.91 gallons per person to 2.06 during the study period. In Illinois, alcohol consumption declined from 3.0 gallons to 2.33. In states such as Missouri, with lower taxes and weaker smoking bans, per capita alcohol consumption came in at 2.44 gallons at the start of the study period and 2.42 gallons by the end.

The new analysis also indicates that a 20 percent increase in cigarette prices could lower per capita alcohol consumption by 2 percent. The researchers also found that if states implement total bans on smoking in bars, restaurants and worksites, that could reduce alcohol consumption by 6 to 7 percent, compared with not having any public smoking bans.

Wine was one exception to the tobacco-alcohol relationship. Although sales of spirits and beer declined in response to increased taxes and stricter smoke-free air policies, wine sales were not affected the same way.

“People who prefer beer or hard liquor are more likely to be smokers than people who drink wine,” Krauss said. “In fact, it turns out that people who prefer wine are not only less likely to smoke but are also more likely to have healthier lifestyle habits and be more educated than people who prefer other types of alcoholic beverages.”

But even including wine drinkers, total per capita alcohol consumption was reduced when states made it harder and more expensive to smoke. Such policies that curtail smoking also could be a boon to public health by limiting some of the damage related to drinking, such as cirrhosis, high blood pressure and depression, not to mention deaths and injuries due to drinking and driving.

“Excluding tobacco, alcohol is by far the deadliest drug in the United States,” Grucza said. “Raising taxes on alcohol would go a long way toward reducing excessive alcohol consumption, but there has been a lot of resistance to doing that. Our study shows that strengthening tobacco-control policies might be another way to accomplish this. By raising cigarette taxes and strengthening smoke-free air laws, states may not only reduce health problems related to smoking but also those related to drinking.”

This work was funded by the National Institute on Drug Abuse (NIDA) and the National Cancer Institute (NCI) of the National Institutes of Health (NIH). NIH grant numbers R01DA031288, K01DA025733, R01DA032843, T32DA07313 P01CA89392.

Krauss MJ, Cavazos-Rehg PA, Plunk AD, Bierut LJ, Grucza RA. Effects of state cigarette excise taxes and smoke-free air policies on state per capita alcohol consumption in the U.S., 1980-2009. Alcoholism: Clinical & Experimental Research, vol. 38 (10), Oct. 2014.
Published online Sept. 23, 2014.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.