Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Martha C. Riddell, DrPH

Committee Member

Kristin B. Ashford, PhD

Committee Member

Jennifer R. Knight, DrPH


Introduction: In the Commonwealth of Kentucky, cigarette smoking results in 1.92 billion dollars spent every year on medical costs, the death of approximately 9,000 Kentuckians, and 34 percent of all cancer cases. In 2017, 14.3 percent of high school students in Kentucky declared being current cigarette smokers, compared to 8.8 percent nationally. Tobacco use among youth is a public health concern because 88 percent of adult smokers initiate smoking before age 18. Youth nicotine use can damage the growing brain, which continues to develop until 25 years of age. In July 2018, the excise tax on cigarettes increased from sixty cents per pack of twenty cigarettes to one dollar and ten cents per pack of twenty in Kentucky. This study aims to assess the impact of the 2018 excise tax policy on cigarettes one year after it had been enacted on tobacco consumption behaviors among youth in Kentucky. Did the policy succeed in reducing cigarette use among youth, or did it influence youth to use other tobacco products, such as e-cigarettes or cigars?

Method: The study uses the Youth Risk Behavior Surveillance System (YBRSS) data to compare tobacco use behaviors among high school students in Kentucky before and post the 2018 price increase on cigarettes. We selected the survey years 2013, 2015, 2017, and 2019 since the YBRSS takes place every two years. We used the YBRSS interactive data analysis tool to perform a t-test analysis, generated custom tables and graphs, and selected only questions on the tobacco use topic. We present prevalence estimates with a 95% confidence interval, and we considered the statistical difference if the t-test P < .05.

Result: After the policy change, the difference in the prevalence of students who tried cigarette smoking was approximately three times more than the changes observed before the policy change. The difference in prevalence of students who currently smoked cigarettes was approximately two times more than the changes observed before the policy change. Cigarette smoking initiation before age 13 rates also decreased after the price increase, by 24 percent. The difference observed in students who used the vapor product was three times more than the change observed before the policy change. The prevalence of current vaping behavior decreased before the policy change and increased after the policy change.

Conclusion: The tax increase on cigarette packs passed in July 2018 succeeded in reaching its goal since the initiation rate, and the use rate decreased on cigarette smoking. Another effect observed after the tax increase on cigarettes was the substantial increase in e-cigarettes use among youth and the lack of change in the cessation rate.

Available for download on Saturday, April 29, 2023

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