The Real Cost of Smoking by State

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. Smokers also may have an increased risk of severe symptoms from COVID-19. In addition, 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.

The economic and societal costs of smoking are just as huge. Every year, smoking costs the U.S. more than $600 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 this 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.

Costs Over a Lifetime

The Real Cost of Smoking by State

*1=Least Costly

Costs per Year

*1=Least Costly

Ask the Experts

Many studies show that smoking can have significant negative physical and financial effects. 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 people 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?

Ask the Experts

Melinda J. Ickes
Ph.D. – Professor, Director of Graduate Studies – University of Kentucky, Department of Kinesiology and Health Promotion
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Julie Williams Merten and Jessica King Jensen
Julie Williams Merten, Ph.D., MCHES – Director, Office of Faculty Excellence; Associate Professor of Public Health – University of North Florida, Faculty Excellence and Academic Engagement | Jessica King Jensen, Ph.D. – Assistant Professor, Health and Kinesiology – University of Utah
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Peter Killeen
Ph.D. – Emeritus Professor, Department of Psychology – Arizona State University
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Christopher W. Kahler
Ph.D. – Professor and Chair, Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies – Brown University School of Public Health
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Clifford E. Douglas
J.D. – Director, Tobacco Research Network; Adjunct Professor, Department of Health Management and Policy – University of Michigan School of Public Health
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Cameron Kaplan
Assistant Professor of Medicine, Keck School of Medicine – University of Southern California
Read More

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 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 21, when a person can legally purchase tobacco products in the U.S. We also assumed a lifespan of 48 more 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 and multiplied that figure by the total number of days in 48 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 drains 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 caused by smoking — and divided that amount by the total number of adult smokers in each state.

Income Loss per Smoker

Previous studies have shown that smoking can lead to loss of income, either because of absenteeism, workplace bias or lower productivity due to smoking-related health problems. This can create a wage gap between smokers and nonsmokers. To represent the negative relationship between earnings and smoking, we assumed an average 18 percent decrease in the median household income for each state. We arrived at this figure after a recent survey from National Longitudinal Surveys found that smokers earn 18.1 percent less than nonsmokers.

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, Centers for Disease Control and Prevention, Insurance Information Institute and Campaign for Tobacco-Free Kids.

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