Harmonization of State E-cigarette and Cigarette Excise Taxes: Association with U.S. State Tobacco Control Interventions

Introduction Excise taxes have proved to be a powerful mechanism to lower demand for tobacco products. The purpose of this study was to summarize current combusted and e-cigarette excise taxes by state, and assess whether harmonization of combusted cigarette and e-cigarette excise taxes is more likely to occur in states comprehensive tobacco control approaches. Methods We compiled excise tax data on e-liquids (whether the state had any e-cigarette excise taxes) and cigarettes (percent of excise tax of total price in dollars per pack of 20) as of September 2022 for all states and the District of Columbia. We derived an index of combusted cigarette/e-cigarette harmonization by classifying excise tax proportion for cigarettes by median split (1/0), and whether a state had any e-cigarette excise tax (1/0). Harmonization was observed when the top (1/1) or bottom (0/0) matched. We used analysis of variance to determine whether the harmonization of cigarette/e-liquid excise taxes differed according to states’ adoption of tobacco control policies and expenditure on tobacco prevention. Results Twenty states did not apply any excise tax on e-liquids. States with harmonized, high excise taxes had the highest mean sum of tobacco control laws (M=4.4, SD=1.2) and the highest mean percent spending on prevention of the CDC recommendation (26.4%). We observed significant differences in the total number of laws (p=0.001), but not percent of tobacco prevention spending, across harmonization categories. Discussion The adoption of harmonized, high excise tax rates for combusted cigarettes and e-cigarettes is consistent with best-practice approaches for state-level tobacco control policy. However, few states have implemented high, harmonized tobacco product excise taxes, highlighting a substantial opportunity in tobacco control policy. Conclusion These findings may inform the development of U.S. federal policy on e-cigarette excise taxes, as well as support bills that aim to equalize tax rates across tobacco products.