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The nation’s most populous state has become a challenge for tobacco tax advocates in recent years. Californians approved a raft of smoking restrictions in the late 1990s and helped drive smokers off the beaches, away from bus stations, and in some cases, out of their own cars and apartments.

The famously health-conscious state has not raised tobacco taxes since 1998, though, and the rest of the country has caught up. If the new tax passed, California would still have only the 16th highest tax rate in the nation.

The overwhelming majority of recent tobacco taxes have been approved in statehouses, not at the polls, according to data compiled for The Associated Press by Campaign for Tobacco-Free Kids.

Missouri voters are expected to weigh in on a tobacco tax increase in November, and similar proposals await action in the Rhode Island, Massachusetts and Illinois statehouses, according to the campaign.

In California, where the smoking rate is just 12.1 percent, lawmakers have defeated more than 30 attempts to raise tobacco taxes in the last 30 years.

Anti-smoking advocates say that far from discouraging them, each defeat at the ballot teaches them how to make their initiative less vulnerable to attack.

“This shows that spending $47 million can get people confused, and when people are confused they tend to vote no,” said Stan Glantz of the University of California, San Francisco’s Center for Tobacco Control Research and Education.

If the measure had directed the money straight to the state’s hemorrhaging general fund, the opposition campaign would not have been able to raise the specter of the tax dollars leaving California, he said.

“But they would have probably thought of something else,” he said.