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

663 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment Tax Conditions for Smoking?

Research shows that increasing cigarette taxes can lead to more people trying to quit smoking and successfully quitting, as seen in studies where tax hikes were linked to higher quit attempts and success rates. This suggests that tax conditions can be an effective treatment to encourage smoking cessation. ^{1 2 3 4 5}

Is the treatment generally safe for humans?

The research does not provide specific safety data for the treatment, but it discusses the challenges in reducing harmful ingredients in cigarettes and the potential health effects of nicotine reduction, which are primarily due to non-nicotine constituents in smoked tobacco. ^{6 7 8 9 10}

How do tax conditions for smoking differ from other treatments for smoking cessation?

Tax conditions for smoking, such as increasing cigarette taxes, are unique because they aim to reduce smoking by making it more expensive, which can deter people from buying cigarettes. This approach is different from other treatments like nicotine replacement therapy or counseling, as it targets the economic aspect of smoking rather than directly addressing the smoker's behavior or addiction. ^{11 12 13 14 15}

What is the purpose of this trial?

In a within-subject design, investigators will use the Experimental Tobacco Marketplace (ETM) to systematically impose 4 novel tobacco/nicotine tax proposals (Tobacco Parity, Nicotine-Content, Harm-Reduction, and Modified Risk Tobacco Product-related taxes) covering a broad range of tax magnitudes. Participants will complete one control trial and all conditions (tax proposals) in the ETM with 5 trials each. Analyses will model the quantity of the product purchased as a function of tax tier (i.e., high, medium, no tax) and examine poly-tobacco purchasing.

Research Team

Jeff Stein, PhD

Principal Investigator

Virginia Polytechnic Institute and State University

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

References

1. Ireland pubmed.ncbi.nlm.nih.gov

Smoking related outcomes before and after implementation of tobacco-free grounds in residential substance use disorder treatment programs. [2023]

2. New Zealand pubmed.ncbi.nlm.nih.gov

Improved patient outcome with smoking cessation: when is it too late? [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Examining quit attempts and successful quitting after recent cigarette tax increases. [2020]

4. England 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. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Use of interrupted time-series method to evaluate the impact of cigarette excise tax increases in Pennsylvania, 2000-2009. [2022]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Impact assessment of WHO TobReg proposals for mandated lowering of selected mainstream cigarette smoke toxicants. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

In search of the less hazardous cigarette. [2017]

8. England pubmed.ncbi.nlm.nih.gov

Who's assessing tobacco use in cancer clinical trials? [2009]

9. United States pubmed.ncbi.nlm.nih.gov

Reduced nicotine product standards for combustible tobacco: building an empirical basis for effective regulation. [2023]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Taxation options for nicotine and tobacco products in Switzerland - a review of tax policies. [2022]

11. United States 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. [2020]

12. United States pubmed.ncbi.nlm.nih.gov

Access to low-taxed cigarettes deters smoking cessation attempts. [2018]

13. United States pubmed.ncbi.nlm.nih.gov

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

14. England pubmed.ncbi.nlm.nih.gov

Who pays the most cigarette tax in Turkey. [2023]

15. United States pubmed.ncbi.nlm.nih.gov

Televised state-sponsored antitobacco advertising and youth smoking beliefs and behavior in the United States, 1999-2000. [2019]