Tax Conditions for Smoking

(AIM2 Trial)

Overseen By Roberta Freitas-Lemos, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Virginia Polytechnic Institute and State University

Disqualifiers: Pregnant, lactating

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 1 session

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different tax proposals on tobacco and nicotine products affect purchasing habits. Researchers aim to determine if taxes can influence the amount and type of tobacco products people buy. Participants will experience several scenarios with varying taxes to observe changes in their choices. The trial seeks individuals who smoke at least 10 cigarettes a day and use other tobacco products less than once a week. Those interested in how taxes might change smoking habits may consider joining. As an unphased trial, this study offers a unique opportunity to contribute to understanding the impact of tax policies on smoking behavior.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these tax conditions are safe for participants?

In a previous study, researchers found that higher cigarette taxes can change smoking behavior. Specifically, 36.1% of participants reported smoking less when taxes increased. This suggests that changing taxes might influence smoking habits, but there is no direct evidence that the tax changes themselves cause any health problems.

This trial examines how different tax proposals affect smoking habits, not a new drug or treatment. Therefore, there is no concern about the safety of a new medication. Instead, the goal is to understand if taxes can help reduce smoking. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the "Tax Conditions for Smoking" trial because it explores an innovative approach to reducing smoking rates through fiscal measures. Unlike traditional smoking cessation methods like nicotine replacement therapies or medications such as varenicline and bupropion, this trial evaluates the impact of different tax conditions. By experimenting with how changes in cigarette taxation can influence smoking behavior, the trial seeks to uncover effective economic strategies for curbing smoking. This approach offers a new angle by leveraging economic incentives, potentially leading to more sustainable public health solutions.

What evidence suggests that this trial's tax conditions could be effective for reducing smoking?

Research has shown that raising taxes on tobacco products effectively reduces smoking rates. In this trial, participants in the "Tax Conditions" arm will encounter various tax scenarios to assess their impact on smoking behavior. Studies have found that when cigarette prices rise due to taxes, fewer people smoke, particularly teenagers and young adults. One study discovered that increasing cigarette taxes by one dollar lowered the number of adult smokers by 8%. Additionally, higher taxes increase the likelihood of people quitting smoking altogether. Overall, the evidence supports that increasing taxes on tobacco products can significantly reduce smoking. ^{6 7 8 9 10}

Who Is on the Research Team?

Jeff Stein, PhD

Principal Investigator

Virginia Polytechnic Institute and State University

Are You a Good Fit for This Trial?

This trial is for individuals who are at least 21 years old, smoke a minimum of 10 cigarettes daily, and use other tobacco products less than weekly. It's not suitable for those who are pregnant or breastfeeding.

Inclusion Criteria

Provide informed consent

I am at least 21 years old.

I smoke 10 or more cigarettes daily and rarely use other tobacco products.

Exclusion Criteria

Pregnant or lactating

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

Treatment

Participants complete a one-session study including consent and behavioral tasks, and make hypothetical purchases of tobacco products under different tax conditions

1 session

1 visit (virtual)

Follow-up

Participants are monitored for purchasing behavior and substitution patterns after exposure to tax conditions

1 week

What Are the Treatments Tested in This Trial?

Interventions

• Control Condition
• Tax Conditions

Trial Overview The study tests how four different tax proposals on tobacco/nicotine affect people's buying habits using an Experimental Tobacco Marketplace (ETM). Participants will face various tax levels and their purchasing patterns across multiple trials will be analyzed.

How Is the Trial Designed?

Group I: Exclusive Cigarette Smokers-Control Condition Experimental Treatment 1 Intervention

Exclusive cigarette smokers will be recruited and will be exposed to the control condition described in the intervention section.

Group II: Exclusive Cigarette Smokers Experimental Treatment 1 Intervention

Exclusive cigarette smokers will be recruited and will be exposed to all of the tax conditions described in the intervention section.

Who Is Running the Clinical Trial?

Virginia Polytechnic Institute and State University

Lead Sponsor

Trials

162

Recruited

26,900+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Published Research Related to This Trial

The implementation of a tobacco-free grounds (TFG) policy in residential substance use disorder (SUD) treatment programs significantly reduced the odds of clients being current smokers, with a 57% decrease compared to baseline.

Increased cigarette taxation did not lead to further reductions in smoking among clients, suggesting that TFG policies may be more effective in promoting smoking cessation in these settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Smoking related outcomes before and after implementation of tobacco-free grounds in residential substance use disorder treatment programs. Gubner, NR., Williams, DD., Le, T., et al.[2023]

Smokers who purchased low-taxed cigarettes from American Indian reservations were significantly less likely to attempt quitting, with only 10% making a quit attempt compared to 20% of those buying full-priced cigarettes.

The study suggests that reducing price differences between low-tax and full-price cigarettes could enhance the effectiveness of cigarette excise taxes in promoting smoking cessation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Access to low-taxed cigarettes deters smoking cessation attempts. Hyland, A., Higbee, C., Li, Q., et al.[2018]

Efforts to create a less harmful cigarette since the 1950s have consistently failed, highlighting the challenges in reducing the health risks associated with smoking.

The 2009 FDA legislation aimed at reducing cigarette harm is uncertain in its efficacy, as it may take up to 20 years to verify any potential health benefits of new products introduced to the market.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

In search of the less hazardous cigarette. Givel, M.[2017]

Smoking cessation is the only proven method to alter the progression of chronic obstructive pulmonary disease (COPD) and significantly reduces the risk of cardiovascular disease (CVD) and lung cancer, benefiting all patients with COPD regardless of severity.

Patients who quit smoking after being diagnosed with early-stage lung cancer or small cell lung cancer experience a substantially lower risk of total mortality and recurrence, highlighting the importance of tobacco treatment as both a primary and secondary intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improved patient outcome with smoking cessation: when is it too late? Wu, J., Sin, DD.[2022]

State cigarette taxation is the most effective policy for reducing smoking rates among the general adult population, with a significant decrease of about 0.25% for every $0.68 increase in taxes.

Different adult subgroups respond variably to tobacco control policies, with taxation particularly benefiting females, older adults, and those with higher education, while tobacco control spending and smoke-free air laws also play important roles for young adults and Hispanic populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

One size fits all? Disentangling the effects of tobacco taxes, laws, and control spending on adult subgroups in the United States. Yu, H., Engberg, J., Scharf, D.[2020]

Low-income households are more sensitive to increases in tobacco excise taxes, spending a higher proportion of their income on cigarettes compared to wealthier groups, but they benefit the most from these tax increases as their smoking consumption significantly declines.

As excise taxes on tobacco products rise, the overall share of household expenditures on cigarettes decreases for all income levels, with the lowest income group experiencing the most significant reduction, indicating that higher taxes can be a progressive measure that also increases government revenue for tobacco control initiatives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Who pays the most cigarette tax in Turkey. Önder, Z., Yürekli, AA.[2023]

Exposure to state-sponsored antitobacco advertisements is linked to positive outcomes among youth, including lower perceived rates of friends' smoking and stronger intentions not to smoke, based on data from 75 media markets and youth surveys.

The study suggests that cuts to antitobacco media campaigns could lead to increased smoking rates among youth, resulting in higher long-term healthcare costs, highlighting the importance of these campaigns in tobacco control efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Televised state-sponsored antitobacco advertising and youth smoking beliefs and behavior in the United States, 1999-2000. Emery, S., Wakefield, MA., Terry-McElrath, Y., et al.[2019]

In a study of 68 interventional cancer trials, only 7% (3 trials) collected data on tobacco use at baseline, and none monitored tobacco use during treatment, highlighting a significant gap in assessing treatment efficacy.

Survey responses indicated that reasons for not collecting tobacco data included uncertainty about its relevance to treatment outcomes and lack of resources, suggesting a need for better tools and encouragement for clinicians to assess tobacco use in cancer trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Who's assessing tobacco use in cancer clinical trials? Gregorio, DI., Hollenbeck, M., Samociuk, H.[2009]

Research indicates that very low nicotine content cigarettes can lead to reduced nicotine exposure, decreased smoking rates, and lower dependence without significant safety issues.

There are still many unknowns regarding the effects of nicotine reduction, particularly concerning gradual versus abrupt changes, impacts on vulnerable populations, and effects on youth, highlighting the need for further research to inform regulatory decisions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reduced nicotine product standards for combustible tobacco: building an empirical basis for effective regulation. Donny, EC., Hatsukami, DK., Benowitz, NL., et al.[2023]

Electronic nicotine delivery systems (ENDS) are likely less harmful than combustible cigarettes, but long-term health effects remain unclear, highlighting the need for careful evaluation of these products.

Taxation strategies for ENDS and tobacco products can influence consumer behavior, but current low prices of tobacco products in Switzerland hinder achieving public health goals, suggesting that significant price increases are necessary to effectively reduce tobacco-related health risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Taxation options for nicotine and tobacco products in Switzerland - a review of tax policies. Merz, L., Puhan, MA.[2022]

Quitting smoking after a diagnosis of early stage lung cancer significantly improves survival rates, with a five-year survival estimate of 70% for quitters compared to 33% for those who continue smoking.

Continued smoking is associated with a higher risk of all-cause mortality and cancer recurrence, highlighting the importance of smoking cessation as a potential strategy to reduce cancer progression and improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. Parsons, A., Daley, A., Begh, R., et al.[2022]

A significant increase in cigarette taxes is associated with higher rates of smoking cessation, as evidenced by a study of over 2,400 past-year smokers in Minnesota, showing that perceived tax effects greatly influenced quit attempts.

Factors such as having a college education, using cessation support, and believing that the tax increase helped maintain quitting were strongly linked to successful long-term cessation, highlighting the effectiveness of tax policies alongside other tobacco control measures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining quit attempts and successful quitting after recent cigarette tax increases. Boyle, RG., Stanton, CA., Sharma, E., et al.[2020]

The second increase in Pennsylvania's cigarette tax led to a significant 5.2% reduction in smoking prevalence among adults aged 18 to 39, indicating that higher cigarette prices can effectively reduce smoking rates in younger populations.

Following the tax increase, there were notable declines in health outcomes, including a 3.87/100,000 reduction in age-adjusted acute myocardial infarction hospitalization rates for men, a 10.05/100,000 decrease in asthma hospitalization rates, and a 1.34/100,000 drop in sudden cardiac death rates among men.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of interrupted time-series method to evaluate the impact of cigarette excise tax increases in Pennsylvania, 2000-2009. Ma, ZQ., Kuller, LH., Fisher, MA., et al.[2022]

The WHO's proposed regulatory models for cigarette emissions could lead to significant non-compliance, with 70%-80% of products failing to meet the standards, especially under the second and third models where non-compliance reached 100% in some countries.

The analysis revealed that the main reasons for non-compliance were related to tobacco-specific nitrosamines and the complexity of applying limits to multiple toxicants, suggesting that the proposed regulations may not effectively reduce toxicant levels as intended.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact assessment of WHO TobReg proposals for mandated lowering of selected mainstream cigarette smoke toxicants. Eldridge, AC., McAdam, KG., Betson, TR., et al.[2023]

Raising tobacco taxes is widely supported by lawmakers and the public, and it has proven effective in reducing tobacco use among price-sensitive groups, particularly adolescents.

Since 2001, 44 states have increased their tobacco taxes, generating significant revenue (approximately $10.2 billion), which can be used to fund health programs like Medicaid, while also being a politically favorable option for increasing state revenue.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Public health: tobacco taxes and Internet sales--2005. End of Year Issue Brief. McKinley, A.[2023]

Citations

1. bmcpublichealth.biomedcentral.com bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13242-5

The association between smoking behaviors and prices and ... The results indicate that higher cigarette prices and taxes were associated with a decrease in smoking prevalence and an increased likelihood of quitting ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0047272723000592

Cigarette taxes, smoking, and health in the long run A one-dollar increase in cigarette taxes experienced at ages 14–17 is associated with an 8 percent reduction in adult smoking participation and a 4 percent ...

3. tobaccoinduceddiseases.org tobaccoinduceddiseases.org/Projecting-the-impact-of-strengthened-tobacco-control-policy-on-disparities-in-US,207750,0,2.html

Projecting the impact of strengthened tobacco control ... Results: Under the tax-only scenario, SA outcomes would be reduced for Tobacco Nation residents below 138% the federal poverty level (FPL) by ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3228562/

Effects of Tobacco Taxation and Pricing on Smoking Behavior ... Most studies found that raising cigarette prices through increased taxes is a highly effective measure for reducing smoking among youth, young adults, and ...

5. link.springer.com link.springer.com/article/10.1007/s00181-024-02674-0

Revisiting the effects of cigarette taxation on smoking ... This study reassesses the efficacy of cigarette taxation in curtailing smoking by leveraging recent advancements in the difference-in-differences (DiD) ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4721304/

Associations between smoking behaviors and financial ... We examine how cigarette use behaviors relate to self-reported financial stress/strain among low-income smokers.

7. who.int who.int/news-room/fact-sheets/detail/tobacco

Tobacco The tobacco epidemic is one of the biggest public health threats the world has ever faced, responsible for over 7 million deaths annually as well as disability.

8. news.gallup.com news.gallup.com/poll/1717/tobacco-smoking.aspx

Tobacco and Smoking | Gallup Historical Trends The table presents responses from smokers on whether they are personally smoking less because of cigarette tax increases, based on data last collected in 2014.

9. frontiersin.org frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.794237/full

Tobacco Taxation Influences the Smoking Habits of Adult ... A study conducted that same year showed that 36.1% of the participants reported a change in their behavior after increased taxation. Furthermore ...

10. tobaccocontrol.bmj.com tobaccocontrol.bmj.com/content/33/e1/e91

As countries improve their cigarette tax policy, cigarette ... Specifically, a unit increase in overall cigarette tax scores is significantly associated with a reduction of 9% in countries' per-capita cigarette consumption.