Smoking doesn’t just ruin your health. It can also burn a nasty hole through your wallet. Tobacco use accounts for nearly half a million deaths in the U.S. each year and is the leading cause of lung cancer, according to the American Lung Association. Even those around tobacco smokers aren’t safe from its harmful effects. Since 1964, smoking-related illnesses have claimed over 20 million lives in the U.S., 2.5 million of which belonged to nonsmokers who developed diseases merely from secondhand-smoke exposure.
However, the economic and societal costs of smoking are just as huge. Every year, smoking costs the U.S. more than $300 billion, which includes both medical care and lost productivity. Unfortunately, some people will have to pay more depending on the state in which they live.
To encourage the estimated 34.2 million tobacco users in the U.S. to kick the dangerous habit, WalletHub looked into the true per-person cost of smoking in each of the 50 states and the District of Columbia. We calculated the potential monetary losses — including both the lifetime and annual cost of a cigarette pack per day, health care expenditures, income losses and other costs — brought on by smoking and exposure to secondhand smoke. Read on for the complete ranking and analysis, insight from a panel of experts and a full description of our methodology.
Thomas E. Novotny MD, MPH, DSc (Hon) – Professor Emeritus, San Diego State University School of Public Health
What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail?
Most people quit on their own (‘cold turkey’), usually after several tries and frustrating failures. Nicotine is a powerful addiction, and nicotine dosing through smoking provides both a calming effect and a stimulant effect for smokers; the craving rarely resolves completely, and so it is important to avoid situations that might encourage a smoker to smoke. Quit-lines are very effective in assisting smokers to quit, especially if they are linked automatically with hospitalized or clinic patients who have smoking-related diseases. FDA-approved OTC pharmaceuticals help many people, including patches, gum, aerosols, and other nicotine replacements. Also, the prescription drugs Welbutrin (bupropion, an anti-depressant) and Chantix (varenicline, which blocks the effect of nicotine in brain receptors) are effective. All of these assists are more effective when combined with counseling, family and friend support, and lots of information about what triggers the need to smoke as well as knowledge about the health consequences of smoking and its economic impacts on the smoker. Some people try to quit using e-cigarettes, but the evidence is still out as to whether these are effective and safe alternatives to smoking. Most e-cig users also use regular cigarettes (dual-use). The most important thing smokers can do is to DECIDE to quit and to pursue this decision with every ounce of energy and all the social support that can be found.
Should e-cigarettes be regulated and taxed as cigarettes or as medical devices?
E-cigarettes should be regulated as tobacco products, as there is no current evidence that they are safe and effective as medical devices. The FDA has yet to review e-cigarette applications as to whether they may be considered either as less risky products or as bona fide smoking cessation assists.
How might marijuana legalization affect tobacco use?
Marijuana legalization confuses people as to where and how it is used as a combustible product. Certainly, laws to prohibit smoking in public places need to be applied similarly to marijuana smoking. If marijuana is used in tobacco products (such as in refillable e-cigarette pods) it needs further regulation according to e-cigarette regulation (which is so far inadequate).
How can state and local authorities encourage people to quit smoking? Is there a role for employers? Health insurance companies?
There is a role for everyone to encourage people to quit smoking. Broad policies such as those implemented by state and local governments provide a non-smoking background against which a person decides to smoke or a smoker decides to quit. Governments must provide frequent, effectively delivered, and consistent information to smokers and especially to children who are the target of tobacco company marketing tactics. Advertising online or through any sort of promotion must be banned; plain packaging can remove tobacco imagery; high taxes on tobacco and e-cigarettes can reduce consumption; restrictions on smoking in any public place help de-normalize tobacco use; and banning the sales of tobacco products with flavors and even the cellulose acetate filters that encourage tobacco use could be very effective in discouraging smoking.
Employers can provide incentives to smokers who quit and should restrict any access to ‘smoking breaks’ unless similar breaks are provided to non-smokers. Strict smoke-free workplaces (indoors and outdoors) will assure safe work environments and healthier employers. There is no right to smoke at any worksite.
Insurance companies should incentivize smoking cessation by providing coverage for approved smoking cessation programs and medications. Companies should make efforts to assure that providers are also incentivized to assess smoking status, advise smokers to quit at every visit, and assist or refer as needed for smoking cessation treatment. These components should be the standard of care for all medical providers’ interactions with smokers.