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Ballot measures to raise taxes on cigarettes were mostly on track to fail by Wednesday morning, and only California appeared to be on track to pass the anti-smoking measure.

Voters in four states were presented with cigarette tax measures, including two separate ballot questions in Missouri that were both disfavored by anti-smoking groups.

By early Wednesday morning, “yes” on California’s measure held a commanding 63 percent lead with 97 percent of the vote in. North Dakota’s proposed increase, however, lost with only 38 percent of the vote and Colorado’s appeared to be failing as votes still come in. Both measures in Missouri failed, although neither will be counted as a loss by anti-smoking advocates.

Health advocates back cigarette taxes as an effective way to reduce smoking. John Schacter, the director of state communications for the Campaign for Tobacco-Free Kids, called it “definitely a great year and a great opportunity” to have cigarette tax hikes on the ballots in California, Colorado and North Dakota.

Missouri’s ballot featured a proposition to raise cigarette taxes by 23 cents a pack and an amendment to raise it by 60 cents, but anti-smoking campaigners saw the increases as too small to discourage smoking. Instead, Missouri became a battleground in a industry-versus-industry contest. Large tobacco companies favored the amendment, which would tax smaller brands for the first time, while smaller companies contributed to the campaign for the smaller tax increase.

In California, the country’s largest state, the battle lines were much more clearly drawn, and the stakes significantly higher. Golden State voters were deciding whether to raise the state tax by $2 a pack and direct the revenues to low-income healthcare programs, in order to raise more than $1 billion in the first year, according to the state legislative analyst’s office.

Altria, the parent company of Philip Morris USA and other cigarette makers, and R.J. Reynolds contributed a combined $69.5 million to the committee to stop the tax.

In Colorado and North Dakota, too, the industry shelled out to stop tax hikes. Altria spent $17.4 million to stop Colorado from voting to raise taxes by $1.75 a pack, and together with Philip Morris spent nearly $4 million to stop a $1.76 per-pack hike on cigarettes and tax increases on other tobacco products in North Dakota.

Anti-cancer groups, hospitals and other nonprofits have supported raising tobacco taxes in the states. While they haven’t been able to match tobacco money, they have the advantage that they are “credible groups that voters recognize, they know them, they trust them,” said Jodi Radke, the regional director for the Campaign for Tobacco-Free Kids.

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Evidence has shown that tobacco taxes are successful in reducing smoking. The Congressional Budget Office reviewed relevant studies and concluded in 2012 that a 1 percent increase in the price of cigarettes yields a 1 percent decrease in youth smoking.

Cigarette smoking is the leading cause of preventable disease and death in the country, and accounts for more than 480,000 lives a year, according to the Centers for Disease Control and Prevention. The Obama White House has said the 62-cent-per-pack federal tax increase that President Obama signed in 2009 will save the lives of 70,000 members of each cohort of people turning 18. Obama has been unsuccessful in gaining support for another 93-cent-per-pack tax hike to pay for expanded preschool.

Nevertheless, critics cite concerns that major increases in tobacco taxes would lead to the creation of black markets. There is some evidence to support that view. For instance, a 2012 analysis of cigarette packs thrown out in the high-tax South Bronx found that three-quarters of the boxes lacked the proper stamps, indicating that they were smuggled into the city.

Users of electronic cigarettes also criticize tobacco taxes that apply to e-cigarettes and other vaping products. Both California and North Dakota’s measures would raise taxes on vaping products. Colorado’s would not, but vapers fear the measure would increase funding for anti-vaping programs.

Whether e-cigarettes should be subject to taxes meant to discourage smoking is a heated topic, with vapers arguing that the products, which are significantly less damaging to smokers’ health, allow smokers to quit more easily. Many anti-smoking groups, however, have said that they should be discouraged because they provide a gateway to smoking.

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Vaping products “are the No. 1 competitor and threat to both Big Tobacco and the ineffective smoking cessation products made by Big Pharma,” said Gregory Conley, founder of the American Vaping Association, a pro-vaping nonprofit.

“Public health is supposed to be about saving lives and reducing disease, not puritanism,” Conley said.

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