1. The rate of infant mortality in the United States decreased from 7.3 to 6.2 per 1000 live births from 1999 through 2010, while state and federal cigarette taxes increased from $0.84 to $2.37.
2. For every $1 increase in cigarette tax throughout the study period, the rate of infant deaths dropped by 3.2%.
Evidence Rating Level: 2 (Good)
Study Rundown: It is known that tobacco use during pregnancy leads to an increased rate of complications for the child, including death. Public taxation of cigarettes has been shown to reduce smoking rates among pregnant women, although no study to date has evaluated its effect on overall infant mortality. Authors of the current study sought to uncover a potential link between cigarette tax and infant mortality and analyzed data from 1999 to 2010 in the United States. Findings indicated that overall, the infant mortality rate decreased significantly, while the price per pack of cigarettes increased significantly. For every $1 increase per pack in cigarette tax, there was an associated decrease in infant mortality, with greater benefits seen in non-Hispanic African American infants than non-Hispanic White infants. This study may be limited by the lack of individual level data (e.g., infant gender, gestational age, and maternal smoking status), unforeseen confounding variables, and the inability to capture variations in city cigarette prices. Nonetheless, the results should continue to encourage further increases in cigarette taxes as well as support providers in recommending smoking cessation in pregnant women.
Relevant Reading: The health consequences of smoking- 50 years of progress
In-Depth [retrospective cohort]: This study included cigarette tax and price data for all 50 states and Washington D.C., obtained from The Tax Burden on Tobacco: Historical Compilation from 1999 to 2010. Data pertaining to educational attainment, state per-capita income, and state infant mortality (death before 1 year of age) were acquired. This potential relationship was evaluated with multivariable regression models, which were stratified by race. Throughout the study period, the mean state infant mortality rate decreased from 7.3 to 6.2 per 1000 births (African American infants: 14.3 to 11.3; White: 6.0 to 5.3). For every $1 increase in cigarette tax, there was an associated -0.19 rate (95% CI -0.33 to -0.05) decrease in infant mortality (African American: -0.46, 95% CI -0.90 to -0.01; White: -0.21, 95% CI -0.33 to -0.08) when controlling for year, educational attainment, per capita income, and state random effects (e.g., cultural beliefs about smoking). When analyzing cigarette price, for every $1 increase in price per pack, there was a -0.19 (95% CI -0.30 to -0.09) rate decrease in infant mortality rates (African American: -0.35, 95% CI -0.68 to -0.01; White: -0.20, 95% CI -0.29 to -0.11).
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