Posted by: Richie Bernardo

Smoking can not only 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 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-related issues are just as staggering. Every year, Americans collectively spend more than $300 billion, which includes “nearly $170 billion in direct medical care for adults” and “more than $156 billion in lost productivity due to premature death and exposure to secondhand smoke.” Unfortunately, some people will have to pay more depending on the state in which they live.

To encourage the estimated 36.5 million tobacco users in the U.S. to kick the dangerous habit, WalletHub’s analysts gauged 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, expert commentary and a full description of our methodology.

1. Costs Over a Lifetime
2. Costs per Year
3. Ask the Experts
4. Methodology

Costs Over a Lifetime

Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/9520/smoke-geochart.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="http://ift.tt/2k53gwH;  

Overall Rank	State	Total Cost per Smoker	Out-of-Pocket Cost (Rank)	Financial Opportunity Cost (Rank)	Health-Care Cost per Smoker (Rank)	Income Loss per Smoker (Rank)	Other Costs per Smoker (Rank)
1	Kentucky	$1,136,524	$88,794(4)	$747,960(4)	$112,220(2)	$178,459(5)	$9,090(3)
2	North Carolina	$1,151,396	$86,374(2)	$727,576(2)	$135,249(10)	$191,221(10)	$10,977(23)
3	Georgia	$1,155,351	$86,932(3)	$732,280(3)	$122,031(4)	$202,450(20)	$11,658(28)
4	Mississippi	$1,184,371	$94,006(10)	$791,866(10)	$124,511(6)	$161,833(1)	$12,155(33)
5	Tennessee	$1,196,502	$93,075(7)	$784,026(7)	$124,329(5)	$184,494(8)	$10,579(15)
6	Alabama	$1,196,752	$94,006(10)	$791,866(10)	$120,869(3)	$177,982(4)	$12,030(31)
7	North Dakota	$1,196,831	$84,140(1)	$708,759(1)	$159,156(29)	$233,298(33)	$11,477(26)
8	South Carolina	$1,202,904	$92,517(6)	$779,322(6)	$133,584(9)	$185,571(9)	$11,912(30)
9	Missouri	$1,203,893	$89,910(5)	$757,369(5)	$149,290(16)	$196,546(15)	$10,778(18)
10	Idaho	$1,254,347	$94,564(13)	$796,570(13)	$158,176(28)	$194,139(14)	$10,898(21)
11	Nebraska	$1,279,930	$93,633(8)	$788,730(8)	$168,829(30)	$216,228(26)	$12,509(35)
12	West Virginia	$1,283,179	$102,755(16)	$865,564(16)	$136,164(11)	$170,344(3)	$8,352(1)
13	Wyoming	$1,292,443	$94,006(10)	$791,866(10)	$155,879(26)	$240,067(35)	$10,626(17)
14	Indiana	$1,303,617	$100,521(15)	$846,748(15)	$145,602(12)	$200,960(16)	$9,786(9)
15	Arkansas	$1,303,731	$107,595(20)	$906,334(20)	$110,583(1)	$168,794(2)	$10,426(13)
16	Oklahoma	$1,306,953	$103,313(18)	$870,268(18)	$128,409(8)	$191,266(11)	$13,696(41)
17	Virginia	$1,311,325	$93,820(9)	$790,298(9)	$150,533(21)	$265,261(43)	$11,413(25)
18	Colorado	$1,331,203	$97,356(14)	$820,091(14)	$153,134(25)	$247,366(38)	$13,255(38)
19	Louisiana	$1,343,210	$108,153(22)	$911,038(22)	$125,504(7)	$183,792(7)	$14,723(45)
20	Oregon	$1,376,898	$107,036(19)	$901,630(19)	$149,952(19)	$209,071(23)	$9,209(4)
21	Montana	$1,390,030	$110,015(25)	$926,718(25)	$150,233(20)	$192,450(12)	$10,615(16)
22	Iowa	$1,394,192	$107,595(20)	$906,334(20)	$152,973(24)	$216,987(27)	$10,304(12)
23	Kansas	$1,397,107	$108,339(23)	$912,606(23)	$149,814(18)	$212,996(25)	$13,351(40)
24	Florida	$1,426,171	$109,829(24)	$925,150(24)	$178,803(35)	$193,829(13)	$18,561(51)
25	Ohio	$1,433,524	$113,924(27)	$959,647(27)	$149,476(17)	$201,670(18)	$8,807(2)
26	Delaware	$1,442,714	$102,941(17)	$867,132(17)	$215,881(43)	$246,877(37)	$9,882(10)
27	Texas	$1,458,738	$113,738(26)	$958,079(26)	$152,540(23)	$217,085(28)	$17,296(50)
28	South Dakota	$1,484,344	$118,578(30)	$998,849(30)	$148,919(15)	$207,905(22)	$10,094(11)
29	New Mexico	$1,487,012	$120,625(31)	$1,016,097(31)	$155,928(27)	$183,449(6)	$10,912(22)
30	Nevada	$1,507,008	$120,811(32)	$1,017,665(32)	$147,279(13)	$211,536(24)	$9,717(8)
31	Utah	$1,530,670	$118,391(29)	$997,281(29)	$151,435(22)	$247,766(39)	$15,797(49)
32	Michigan	$1,569,963	$128,444(35)	$1,081,955(35)	$147,808(14)	$202,270(19)	$9,486(5)
33	Maine	$1,598,933	$126,210(34)	$1,063,139(34)	$198,817(40)	$201,270(17)	$9,496(6)
34	New Hampshire	$1,599,037	$115,971(28)	$976,896(28)	$222,162(45)	$272,458(44)	$11,549(27)
35	Arizona	$1,631,475	$131,794(36)	$1,110,180(36)	$172,767(31)	$205,040(21)	$11,693(29)
36	Maryland	$1,680,774	$123,604(33)	$1,041,186(33)	$199,748(41)	$304,168(51)	$12,068(32)
37	Wisconsin	$1,692,054	$136,634(37)	$1,150,950(37)	$177,100(33)	$217,697(29)	$9,674(7)
38	Pennsylvania	$1,742,938	$141,660(39)	$1,193,287(39)	$178,827(36)	$218,684(30)	$10,479(14)
39	Illinois	$1,770,563	$141,660(39)	$1,193,287(39)	$188,453(37)	$234,902(34)	$12,261(34)
40	New Jersey	$1,836,402	$138,496(38)	$1,166,630(38)	$223,227(46)	$294,139(49)	$13,911(43)
41	Washington	$1,840,743	$148,920(43)	$1,254,441(43)	$177,417(34)	$249,133(40)	$10,832(20)
42	California	$1,863,218	$148,362(42)	$1,249,737(42)	$198,103(39)	$252,217(42)	$14,799(47)
43	District of Columbia	$1,894,010	$144,266(41)	$1,215,240(41)	$232,443(48)	$289,060(48)	$13,001(37)
44	Minnesota	$1,904,792	$153,760(44)	$1,295,210(44)	$191,621(38)	$250,887(41)	$13,313(39)
45	Vermont	$1,916,093	$154,877(45)	$1,304,619(45)	$220,381(44)	$225,118(31)	$11,098(24)
46	Hawaii	$2,048,587	$167,535(48)	$1,411,246(48)	$173,258(32)	$283,621(46)	$12,926(36)
47	Alaska	$2,056,066	$162,881(46)	$1,372,045(46)	$214,495(42)	$295,861(50)	$10,784(19)
48	Rhode Island	$2,063,847	$166,232(47)	$1,400,270(47)	$251,097(49)	$231,956(32)	$14,291(44)
49	Connecticut	$2,183,204	$170,513(49)	$1,436,335(49)	$274,272(50)	$286,950(47)	$15,133(48)
50	Massachusetts	$2,197,197	$172,189(50)	$1,450,447(50)	$280,080(51)	$279,737(45)	$14,744(46)
51	New York	$2,313,025	$194,341(51)	$1,637,046(51)	$226,057(47)	$241,818(36)	$13,764(42)

 

Costs per Year

 

Overall Rank	State	Total Cost per Smoker	Out-of-Pocket Cost (Rank)	Financial Opportunity Cost (Rank)	Health-Care Cost per Smoker (Rank)	Income Loss per Smoker (Rank)	Other Costs per Smoker (Rank)
1	Kentucky	$22,285	$1,741(4)	$14,666(4)	$2,200(2)	$3,499(5)	$178(3)
2	North Carolina	$22,576	$1,694(2)	$14,266(2)	$2,652(10)	$3,749(10)	$215(23)
3	Georgia	$22,654	$1,705(3)	$14,358(3)	$2,393(4)	$3,970(20)	$229(28)
4	Mississippi	$23,223	$1,843(10)	$15,527(10)	$2,441(6)	$3,173(1)	$238(33)
5	Tennessee	$23,461	$1,825(7)	$15,373(7)	$2,438(5)	$3,618(8)	$207(15)
6	Alabama	$23,466	$1,843(10)	$15,527(10)	$2,370(3)	$3,490(4)	$236(31)
7	North Dakota	$23,467	$1,650(1)	$13,897(1)	$3,121(29)	$4,574(33)	$225(26)
8	South Carolina	$23,586	$1,814(6)	$15,281(6)	$2,619(9)	$3,639(9)	$234(30)
9	Missouri	$23,606	$1,763(5)	$14,850(5)	$2,927(16)	$3,854(15)	$211(18)
10	Idaho	$24,595	$1,854(13)	$15,619(13)	$3,101(28)	$3,807(14)	$214(21)
11	Nebraska	$25,097	$1,836(8)	$15,465(8)	$3,310(30)	$4,240(26)	$245(35)
12	West Virginia	$25,160	$2,015(16)	$16,972(16)	$2,670(11)	$3,340(3)	$164(1)
13	Wyoming	$25,342	$1,843(10)	$15,527(10)	$3,056(26)	$4,707(35)	$208(17)
14	Indiana	$25,561	$1,971(15)	$16,603(15)	$2,855(12)	$3,940(16)	$192(9)
15	Arkansas	$25,563	$2,110(20)	$17,771(20)	$2,168(1)	$3,310(2)	$204(13)
16	Oklahoma	$25,627	$2,026(18)	$17,064(18)	$2,518(8)	$3,750(11)	$269(41)
17	Virginia	$25,712	$1,840(9)	$15,496(9)	$2,952(21)	$5,201(43)	$224(25)
18	Colorado	$26,102	$1,909(14)	$16,080(14)	$3,003(25)	$4,850(38)	$260(38)
19	Louisiana	$26,337	$2,121(22)	$17,863(22)	$2,461(7)	$3,604(7)	$289(45)
20	Oregon	$26,998	$2,099(19)	$17,679(19)	$2,940(19)	$4,099(23)	$181(4)
21	Montana	$27,255	$2,157(25)	$18,171(25)	$2,946(20)	$3,774(12)	$208(16)
22	Iowa	$27,337	$2,110(20)	$17,771(20)	$2,999(24)	$4,255(27)	$202(12)
23	Kansas	$27,394	$2,124(23)	$17,894(23)	$2,938(18)	$4,176(25)	$262(40)
24	Florida	$27,964	$2,154(24)	$18,140(24)	$3,506(35)	$3,801(13)	$364(51)
25	Ohio	$28,108	$2,234(27)	$18,817(27)	$2,931(17)	$3,954(18)	$173(2)
26	Delaware	$28,289	$2,018(17)	$17,003(17)	$4,233(43)	$4,841(37)	$194(10)
27	Texas	$28,603	$2,230(26)	$18,786(26)	$2,991(23)	$4,257(28)	$339(50)
28	South Dakota	$29,105	$2,325(30)	$19,585(30)	$2,920(15)	$4,077(22)	$198(11)
29	New Mexico	$29,157	$2,365(31)	$19,923(31)	$3,057(27)	$3,597(6)	$214(22)
30	Nevada	$29,549	$2,369(32)	$19,954(32)	$2,888(13)	$4,148(24)	$191(8)
31	Utah	$30,013	$2,321(29)	$19,555(29)	$2,969(22)	$4,858(39)	$310(49)
32	Michigan	$30,784	$2,519(35)	$21,215(35)	$2,898(14)	$3,966(19)	$186(5)
33	Maine	$31,352	$2,475(34)	$20,846(34)	$3,898(40)	$3,946(17)	$186(6)
34	New Hampshire	$31,354	$2,274(28)	$19,155(28)	$4,356(45)	$5,342(44)	$226(27)
35	Arizona	$31,990	$2,584(36)	$21,768(36)	$3,388(31)	$4,020(21)	$229(29)
36	Maryland	$32,956	$2,424(33)	$20,415(33)	$3,917(41)	$5,964(51)	$237(32)
37	Wisconsin	$33,178	$2,679(37)	$22,568(37)	$3,473(33)	$4,269(29)	$190(7)
38	Pennsylvania	$34,175	$2,778(39)	$23,398(39)	$3,506(36)	$4,288(30)	$205(14)
39	Illinois	$34,717	$2,778(39)	$23,398(39)	$3,695(37)	$4,606(34)	$240(34)
40	New Jersey	$36,008	$2,716(38)	$22,875(38)	$4,377(46)	$5,767(49)	$273(43)
41	Washington	$36,093	$2,920(43)	$24,597(43)	$3,479(34)	$4,885(40)	$212(20)
42	California	$36,534	$2,909(42)	$24,505(42)	$3,884(39)	$4,945(42)	$290(47)
43	District of Columbia	$37,137	$2,829(41)	$23,828(41)	$4,558(48)	$5,668(48)	$255(37)
44	Minnesota	$37,349	$3,015(44)	$25,396(44)	$3,757(38)	$4,919(41)	$261(39)
45	Vermont	$37,570	$3,037(45)	$25,581(45)	$4,321(44)	$4,414(31)	$218(24)
46	Hawaii	$40,168	$3,285(48)	$27,671(48)	$3,397(32)	$5,561(46)	$253(36)
47	Alaska	$40,315	$3,194(46)	$26,903(46)	$4,206(42)	$5,801(50)	$211(19)
48	Rhode Island	$40,468	$3,259(47)	$27,456(47)	$4,923(49)	$4,548(32)	$280(44)
49	Connecticut	$42,808	$3,343(49)	$28,163(49)	$5,378(50)	$5,626(47)	$297(48)
50	Massachusetts	$43,082	$3,376(50)	$28,440(50)	$5,492(51)	$5,485(45)	$289(46)
51	New York	$45,353	$3,811(51)	$32,099(51)	$4,432(47)	$4,742(36)	$270(42)

 

Ask the Experts

As studies have shown, the negative physical and financial effects of smoking can be significant. To advance the discussion, we asked a panel of experts to share their insight regarding smoking-cessation programs, e-cigarettes and other smoking-related concerns. Click on the experts’ profiles to read their bios and responses to the following key questions:

1. What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail?
2. Should e-cigarettes be regulated and taxed as cigarettes or as medical devices?
3. How might marijuana legalization affect tobacco use?
4. How can state and local authorities encourage people to quit smoking? Is there a role for employers, health insurance companies?

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• Steven A. Branstetter Associate Professor of Biobehavioral Health at Pennsylvania State University
• Kenneth D. Ward Professor and Director of the Division of Social and Behavioral Sciences and Interim Director of Health Systems Management and Policy in the School of Public Health at University of Memphis
• Doug Brugge Professor of Public Health and Community Medicine at Tufts University
• Michael Darden Assistant Professor of Economics at Tulane University
• Scott E. Sherman Associate Professor of Population Health, Medicine and Psychiatry and Co-Chief of the Section of Tobacco, Alcohol and Drug Use at NYU School of Medicine
• Marie Helweg-Larsen Professor of Psychology and Chair of the Health Studies Certificate Program at Dickinson College
• Harry A. Lando Professor in the Division of Epidemiology & Community Health at University of Minnesota
• Yi-Yuan Tang Founding Director of Texas Tech Neuroimaging Institute, Presidential Endowed Chair in Neuroscience and Professor in the Department of Psychological Sciences and Internal Medicine at Texas Tech University

Steven A. Branstetter Associate Professor of Biobehavioral Health at Pennsylvania State University What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail? One of the most effective approaches to reducing smoking has been increasing taxes. The Framework Convention on Tobacco Control and others have established that price control of tobacco through taxation is an effective strategy to reduce demand internationally. Although this approach works better in some populations than others, it is perhaps the most straight-forward and effective approach to reducing smoking at the population-level. For every 10% increase in taxes, there is a corresponding reducing in smoking of up to 15% in youth smokers and up to 7% in adult smokers. Our own research has been looking at if it might be possible to have smokers select less-addictive cigarettes with less nicotine by basing the price of cigarettes on the amount of nicotine -- with cigarettes containing little or no nicotine costing significantly less than full-nicotine cigarettes. In theory, as smokers selected lower nicotine cigarettes, quitting would be easier and smoking would be less "rewarding" overall. The list of things that do not work is longer and exhaustive - perhaps the "worst" way to quit are things like hypnosis and cold turkey. This is a tricky one - you will hear some people tell you cold turkey is the most effective method - in fact, most people who quit have done so using cold turkey. However, it is the most attempted and most failed method, so it's also natural that - given the large numbers - you will find a large number of people who have done it successfully. However, most smokers have attempted and failed - multiple times - using this method. Methods such as nicotine replacements, pharmaceuticals and behavioral therapy are pretty good, but there is a long way to go in the field. The best approaches (beyond taxation) have quit rates of no more than 25-30%. That's still a 70-75% failure rate. Should e-cigarettes be regulated and taxed as cigarettes or as medical devices? I think electronic cigarettes and other nicotine delivery products should be regulated as cigarettes rather than medical devices. There is too little and unconvincing research that these products are utilized for, or effective as, cessation or reduction aids. Whereas the jury is still out regarding the extent of the health consequences of electronic products, there is sufficient evidence that they can be addictive and deliver nicotine efficiently. There is also emerging evidence that these products may have their own unique risks and health issues. How can state and local authorities encourage people to quit smoking? Is there a role for employers? Health insurance companies? I believe there is a large role for employers and insurance companies in smoking cessation. One approach that has been studied with some efficacy is simply paying employees to quit smoking. As we have found, with higher taxation resulting in lower smoking rates, smokers (like the rest of us) make decisions based on economic considerations - I think further research could find the right balance between paying employees to quit and the benefits in reduced health care costs. Kenneth D. Ward Professor and Director of the Division of Social and Behavioral Sciences and Interim Director of Health Systems Management and Policy in the School of Public Health at University of Memphis What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail? The most effective way to quit smoking is behavioral counseling in combination with medication (nicotine replacement products, Zyban, or Chantix). Most people quit on their own without assistance, but the likelihood of success is substantially improved with these tools. Some popular tools that smokers use to quit, which have not been shown to be helpful are acupuncture, hypnosis, over the counter herbal remedies, and low-level laser treatment. Should e-cigarettes be regulated and taxed as cigarettes or as medical devices? This is a question that’s getting lots of attention right now. E-cigarettes potentially could help cigarette smokers to quit, but they also have the potential to cause nicotine addiction in non-smokers, particularly teens. The jury is still out about e-cigarettes usefulness as a cessation aid, while at the same time there’s growing evidence that young people who use e-cigarettes are more likely to initiate use of cigarettes and other combustible (and dangerous) tobacco products, such as hookah. Tax policy has to grapple with these concerns while the data are still coming in. How can state and local authorities encourage people to quit smoking? Is there a role for employers? Health insurance companies? Comprehensive tobacco control policies are the most effective; these include taxation, advertising restrictions, clean air laws, restricted youth access, and access to affordable cessation treatment. Employers and health insurance companies both have important roles in encouraging people to quit and providing access to cessation services. Fortunately, cessation treatment is highly cost-effective. Doug Brugge Professor of Public Health and Community Medicine at Tufts University What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail? I have not followed this closely in recent years, but the last I looked at it the main impression I had was that even the best cessation programs had modest to poor success rates. Should e-cigarettes be regulated and taxed as cigarettes or as medical devices? The paradox of e-cigs, as I see it, is that they can either help an addicted smoker get off the toxic stew that they inhale from burning tobacco or they could addict non-smokers who think it is safer than cigarettes. Given the adverse potential, especially for underage youth, who are after all the people most prone to become addicted to nicotine, I think they need to be regulated at least to restrict use by children. How might marijuana legalization affect tobacco use? I am concerned that marijuana users do not understand that inhaling any combustion product, and especially the concentrated toxins during active smoking, is hazardous. There is a lot of misinformation that marijuana smoke is somehow not toxic. In fact, all combustion produces particles and gasses that cause adverse health effects. How can state and local authorities encourage people to quit smoking? Is there a role for employers? Health insurance companies? Getting people to quit smoking is hard. Increased cost of cigarettes drives down smoking rates some. And cessation programs have some limited success. But I think the main thing has to be to prevent new smokers from starting, given how hard it is to get people to quit. We should focus on youth, which is when the vast majority of smoking starts. Making smoking uncool seems to me the best way to reduce its appeal to young people. Michael Darden Assistant Professor of Economics at Tulane University What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail? People point to cigarette taxes as the obvious policy lever to encourage smoking cessation, but the data do not generally support the idea that current cigarette tax increases reduce smoking. Indeed, average cigarette taxes did not start to increase dramatically until around 1990, but the huge decline in smoking from its peak in the mid-twentieth century largely happened in the 60s, 70s, and 80s. In fact, recent estimates suggest that it would take a 100% increase in cigarette taxes to decrease smoking prevalence by just 5%. However, the national average estimates of the effects of taxes on smoking do hide large regional differences: cigarette taxes are considerably higher in the northeast and west coast. Generally, the extent to which state and local policies may encourage smoking cessation varies for light versus heavy smokers. For light smokers, some combination of more dramatic warning labels (or health information campaigns generally), higher taxes, and indoor smoking bans have been shown to be effective. For heavy smokers with a strong nicotine addiction, policies designed to encourage cessation need to increasingly heavy-handed. For example, consider the case of information campaigns. How can we expect warning labels to encourage cessation when some evidence shows that heavy smokers often fail to quit following a smoking-related health shock to their spouse? Heavy smokers don't quit because policy makers ban smoking in bars, they simply stop going to bars - and there is evidence that health concerns for children from secondhand smoke increased following state-level indoor smoking bans. But I do think that indoor smoking bans may have an important long-run effect on heavy smoking by de-normalizing cigarette smoking. Research suggests that, compared to the 1970s, smokers are much more isolated today - friend groups are in some sense more defined by smoking. This is partly due to information campaigns (policy) that has made smoking less socially acceptable. In the short-term, for heavy smokers, the literature suggests that personalized sources of information and interventions are needed. From a policy perspective, I think it's important to consider unintended consequences. For example, the ACA allows health insurance companies offering plans on the exchanges to charge up to a 50% surcharge on premiums for smokers. Clearly this reflects the fact that smokers are more costly/risky from the perspective of the insurance firm. While we might expect this surcharge to convince light smokers to quit, it could also be the case that heavy smokers simply forgo purchasing health insurance. Scott E. Sherman Associate Professor of Population Health, Medicine and Psychiatry and Co-Chief of the Section of Tobacco, Alcohol and Drug Use at NYU School of Medicine What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail? The most effective strategies are medications and counseling. There are seven medications approved by the Food & Drug Administration for quitting smoking – five forms of nicotine replacement therapy (nicotine patch, gum, lozenge, nasal spray or inhaler) and two non-nicotine medications (bupropion and varenicline). All of the medications either double or triple someone’s chances of quitting smoking in general. Counseling also generally doubles someone’s chances of quitting and the more counseling the better. Counseling can be delivered by telephone and every state has a free telephone Quitline. Counseling can also be delivered in person (individually or in groups) and by text message. A great place to find quitting resources is Smokefree.gov, run by the National Cancer Institute. The combination of medications and counseling is even better than either one alone. Many people try to quit on their own, which can work but is much harder and less successful that using medications and/or counseling. I tell my patients that the tobacco companies have invested so much in getting them hooked, so why not give themselves every bit of help possible. Should e-cigarettes be regulated and taxed as cigarettes or as medical devices? I feel that e-cigarettes should be regulated but not taxed. There is still considerable debate about the overall public health impact of e-cigarettes. However, nearly all experts agree that e-cigarettes are much, much less harmful than combustible cigarettes. The goal is to use them to help people quit (not just cut down) and many people indeed have quit using e-cigarettes. Taxing them mean fewer people would use them to quit smoking and therefore there would likely be more smokers. Taxes have been the most effective public health strategy at lowering the prevalence of cigarette smoking. In this case, it could have the opposite effect, since higher taxes would mean fewer people using a potentially helpful strategy for quitting. How can state and local authorities encourage people to quit smoking? Is there a role for employers? Health insurance companies? The two biggest things state and local authorities can do to encourage people to quit smoking are: 1) increase taxes on cigarettes (preferably with tax revenues directed towards further programs to help people quit) and 2) pass (and enforce) clean indoor air laws, which ban smoking indoors. Employers can also have a role, both by offering treatment and by ensuring that all health plans they offer include smoking cessation treatment. Employer incentives to help people quit also work but should be done in a way that is equitable for non-smokers. And finally, insurers should all cover smoking cessation treatment. When all preventive interventions were reviewed, smoking cessation treatment and childhood vaccinations were the two most cost-effective preventive services, enough for people to describe smoking cessation treatment as the “gold standard for cost-effectiveness.” Marie Helweg-Larsen Professor of Psychology and Chair of the Health Studies Certificate Program at Dickinson College What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail? There is no one methods that works for everyone. Quitting smoking is very hard and smokers typically need to try many times before they quit for good. Many employers, communities and states have free or reduced-fee counseling (phone, online, or in person) and nicotine replacement products. The key for an individual smoker is to think about the many benefits associated with quitting (not just health benefits but also financial benefits, improved dental health, improved mental health, better relationship at home and at work, etc.) and get social support in establishing new habits and relationships. Even if a given quit attempt is not ultimately successful, it is one-step closer to quitting for good. And any period of time without smoking is good for the body and the wallet. Harry A. Lando Professor in the Division of Epidemiology & Community Health at University of Minnesota What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail? The USDHHS 2008 Clinical Practice Guideline has good recommendations. The likelihood of success is increased by use of an FDA approved medication and also by counseling. Support from others can be exceedingly helpful. Being able to engage in effective coping and problem solving strategies also is useful. Simply relying on “will power” without other sources of support is less likely to be successful. Treatobacco also is a good resource. Should e-cigarettes be regulated and taxed as cigarettes or as medical devices? E-cigarettes definitely should be regulated. There is a lot that we do not know currently, including long-term effects. Most regular smokers who also use e-cigarettes continue to smoke and may not appreciably reduce their risk, if they reduce their risk at all. Different e-cigarettes may have different toxicity profiles and e-cigarettes are continuing to change and evolve. Almost surely, they are safer than conventional cigarettes, but it is unclear that they will have positive public health impact. Adequate levels of taxation also are important. I am not very knowledgeable about the differential implications of treating e-cigarettes as cigarettes as opposed to medical devices. How might marijuana legalization affect tobacco use? Unclear. Cigarette smokers also are more likely to use marijuana. I think we need more time to assess trends. How can state and local authorities encourage people to quit smoking? Is there a role for employers? Health insurance companies? CDC has a document that describes best practices for promoting tobacco reduction, including cessation. Adequate funding of tobacco control programs is critical, and few states meet the CDC recommended funding guidelines. It is important that tobacco users have access to effective treatments, including counseling and medication. Smokers in all 50 states and DC can access quitlines. Employers can subsidize tobacco cessation programs including medications and large employers can offer programs onsite. Health insurance companies can cover cessation programs and medications. Both employers and health insurance companies could offer incentives for quitting. Some insurers give preferential rates to nonsmokers. Yi-Yuan Tang Founding Director of Texas Tech Neuroimaging Institute, Presidential Endowed Chair in Neuroscience and Professor in the Department of Psychological Sciences and Internal Medicine at Texas Tech University What are the most effective strategies for individuals trying to quit smoking? What approaches typically fail? Combination of brain based treatments that target on self-control system and intention to quit. If smokers only rely intention or motivation, it often fails. Should e-cigarettes be regulated and taxed as cigarettes or as medical devices? Since e-cigarettes have nicotine, the same chemical that induces craving and addiction with cigarettes, in principle they should be treated as cigarettes. How might marijuana legalization affect tobacco use? Although several surveys and studies have suggested that marijuana legalization lead to increase use of marijuana, while tobacco use decreases in some degree. However, more rigorous research is warranted. How can state and local authorities encourage people to quit smoking? Is there a role for employers? Health insurance companies? Quit smoking can be facilitated by state and local authorities, as well as social support. Employers and health insurance companies can help with this behavior change - smoking quitting.

Methodology

In order to assess the impact of tobacco use on a smoker’s finances both over a lifetime and in a single year, WalletHub’s analysts calculated the potential monetary losses — including the cumulative cost of a cigarette pack per day over several decades, health-care expenditures, income losses and other costs — brought on by smoking and exposure to secondhand smoke.

For our calculations, we assumed an adult who smokes one pack of cigarettes per day beginning at age 18, when a person can legally purchase tobacco products in the U.S. We also assumed a lifespan thereafter of 51 years, taking into account that 69 is the average age at which a smoker dies.

Out-of-Pocket Costs

To determine per-person Out-of-Pocket Costs Over a Lifetime, we took the average cost of a pack of cigarettes in each state, multiplied that figure by the total number of days in 51 years. For Costs per Year, we multiplied the average cost by 365 days.

Financial Opportunity Cost

To determine the per-person Financial Opportunity Cost, we calculated the amount of return a person would have earned by instead investing that money in the stock market over the same period. We used the historical average market return rate for the S&P 500 minus the inflation rate during the same time period to reflect the return in present-value terms.

Health-Care Cost per Smoker

Direct medical costs to treat smoking-connected health complications are one of the biggest financial detriments caused by tobacco use. To calculate related health-care costs, we obtained state-level data from the Centers for Disease Control and Prevention — namely the annual health care costs incurred from smoking — and divided that amount by the total number of adult smokers in each state.

Income Loss per Smoker

Previous studies have demonstrated that smoking can lead to loss of income — either because of absenteeism, workplace bias or lower productivity due to smoking-induced health problems — and create a wage gap between smokers and nonsmokers. To represent the negative relationship between earnings and smoking, we assumed an average 8 percent decrease in the median household income for each state. We arrived at this figure after accounting for the fact that, according to a recent study from the Federal Reserve Bank of Atlanta, smokers earn 20 percent less than nonsmokers, 8 percent of which is attributed to smoking and 12 percent to other factors.

Other Costs per Smoker

Nonsmokers are generally entitled to a homeowner’s insurance credit of between 5 and 15 percent, according to the Independent Insurance Agents & Brokers of America. Given that fact, we assumed an 11.1 percent increase (i.e. the inverse of a 10 percent credit, or the average between the two percentages) in the average homeowner’s insurance premium for each state to represent the penalty cost for smokers.

We then took into account the costs for victims of secondhand-smoke exposure. To calculate these costs, we used the per-nonsmoker expenditure in the state of New York as a proxy. We then multiplied that figure by the number of nonsmokers in each state to obtain the total costs of exposure to secondhand smoke at the state level. Finally, we divided the resulting total by the number of smokers in each state. This approach assumes that, in a perfect society, smokers would also pay the costs related to the harmful smoke that tobacco releases into the air.

Formula for Financial Cost of Smoking

Financial Cost of Smoking = Out-of-Pocket Costs + Financial Opportunity Cost + Related Health-Care Costs + Income Loss Due to Smoking-Related Issues + Increase in Homeowner's Insurance Premium + Secondhand Smoke-Exposure Costs

Sources: Data used to create this ranking were collected from the U.S. Census Bureau, Bureau of Labor Statistics, Centers for Disease Control and Prevention, Insurance Information Institute, NYsmokefree.com, Federal Reserve Economic Data (FRED), Kaiser Family Foundation and the Independent Insurance Agents & Brokers of America.

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