Each time over the past decade or so that New York state increased its tobacco tax 鈥� now at $4.35 per pack of cigarettes 鈥� calls to the state鈥檚 Quitline spiked.
And as high as the state tobacco tax went, in New York City, then-Mayor Michael Bloomberg even more.
鈥淚 was so angry with him, I could hardly afford it,鈥� says Elizabeth Lane, a Harlem resident who paid $12 a pack. 鈥淚 had to beg, borrow and steal to get money to buy cigarettes.鈥�
At first, Lane cut down to four packs a week from seven. But even so, she sometimes didn鈥檛 have money to buy laundry detergent or toilet paper. Then in 2013, after smoking for 40 years, the price tag, her doctor鈥檚 warnings and her daughter鈥檚 guilt trips all came together.
She quit.
鈥淚 said, 鈥楲ord, I鈥檝e been waiting a long time for this. When will you answer my prayer?鈥欌�� she says. 鈥淎nd he answered this time.鈥�
Four states will vote on whether to raise their tobacco tax in November: California (by $2), Colorado ($1.75), North Dakota ($1.76) and Missouri (15 cents). California currently has one of the lowest cigarette taxes in the country: 87 cents per pack. If voters pass in November, the tax would go up to $2.87 a pack. Backers of the measure, including the American Cancer Society and the American Lung Association, hope to hit people hard enough in the wallet that they quit smoking, or never start.
Studies support the goal. For every 10 percent increase in the price of cigarettes, smoking goes down 4 percent, according to a on smoking by the U.S. surgeon general.
鈥淧art of that is people quitting. Part of that is people cutting down,鈥� said Stanton Glantz, a professor of medicine at University of California, San Francisco and director of the Center for Tobacco Control Research and Education.
In New York City, smoking rates declined from of adults to in the 12 years after the tax, and a ban on smoking in restaurants and bars, was implemented.
California鈥檚 smoking rate is about 12 percent, the second lowest in the country after Utah. Most people in California who do smoke, Glantz said, don鈥檛 smoke that much.
鈥淚t may be that a price increase that will follow Prop. 56 will be enough to just get these light, intermittent smokers to just say, 鈥楩orget it,鈥欌�� he said.
Behavioral economist Justin White, a colleague of Glantz鈥檚, said the vast majority of smokers wish they could quit. They know it鈥檚 bad for them. But addiction is a powerful force.
鈥淭here鈥檚 this universal tendency toward immediate gratification,鈥� White said.
The craving for a cigarette right now easily overwhelms fears of heart disease or lung cancer in the future. But, White said, a cigarette tax that is high enough can flip that. A tax evident at the time of purchase has the power to compete with the desire for a cigarette.
鈥淚ncreasing taxes is a way to really bring that back to equilibrium, the cost in the future versus the benefits now,鈥� White said.
The question is, how much. He said a $1 or $2 tax is enough to sway smokers with a mild self-control problem. But for smokers with a strong addiction, the tax needs to be between $5 and $10 to work.
Either way, White said, a tax is most effective when paired with support from a cessation program.
And this is where opponents have been digging into Proposition 56. The 鈥淣o on 56鈥� campaign, backed by tobacco companies R.J. Reynolds and Philip Morris, has raised $56 million to defeat the measure. Supporters have raised $17.5 million.
Opponents are investing in that say proponents 鈥渁re telling us Proposition 56 is all about helping people stop smoking. But follow the money, and you鈥檒l find out that only 13 percent of the new taxes would actually help people quit.鈥�
This is true. Of the that Proposition 56 is expected to raise from the tax, 13 percent would go to the state鈥檚 cessation programs. The rest of the tax money would go to Medi-Cal, the state鈥檚 low-income health care program, which covers care for one in three Californians.
But UCSF professor Glantz said that $100 million for smoking-cessation programs is enough money to fully serve all would-be quitters who need help.
Opponents ultimately reject the tax, no matter how the revenues would be spent.
鈥淚鈥檓 opposed to every manner of taxing,鈥� said Steven Greenhut, Western Region director for the R Street Institute, a free market think tank that promotes limited government. 鈥淟et people make their own choices.鈥�
He doesn鈥檛 like that Proposition 56 would tax e-cigarettes, too.
鈥淰aping is not entirely safe,鈥� he said. 鈥淏ut it鈥檚 pretty clear that vaping is far less harmful than smoking.鈥�
Early studies suggest that e-cigarettes may have fewer health effects than cigarettes. Still, that became effective in August, the Food and Drug Administration said that some studies have found toxic material in e-cigarette liquid and the exhaled vapor. But, the agency said, 鈥渨e do not have sufficient data to determine what effects e-cigarettes have on public health at the population level.鈥�
In any event, Greenhut said it鈥檚 premature to tax e-cigarettes.
For Elizabeth Lane in New York, the nicotine patch was her ticket to quitting. Now, she no longer huffs and puffs when she walks.
鈥淚 can walk up stairs. I don鈥檛 cough,鈥� she says. 鈥淎nd the circulation in my legs has improved.鈥�
She says now she saves the money that she used to spend on cigarettes so she can buy birthday and Christmas presents for her daughter and granddaughter.
鈥淚nstead of being on the receiving end all the time, you know, give me, give me, give me,鈥� she says, 鈥淚 can give now.鈥�
This story is part of a partnership that includes聽NPR, KQED, WNYC, NPR and Kaiser Health News. WNYC鈥檚 Fred Mogul contributed to this report.