Tax Strategies for Smoking Behavior

No longer recruiting at 2 trial locations

Overseen By Roberta Freitas Lemos, Ph.D.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Virginia Polytechnic Institute and State University

Must not be taking: Smoking cessation medications

Disqualifiers: Uncontrolled conditions, Pregnancy, others

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

Compensation: Varies

Number of Visits: 6

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to examine how different tax proposals affect cigarette buying habits. It will test four types of taxes: Tobacco Parity, Nicotine-Content, Harm-Reduction, and Modified Risk Tobacco Product taxes. The trial targets individuals who smoke at least 10 cigarettes a day and do not regularly use other tobacco products. Participants will experience different tax conditions to observe changes in their purchasing behavior.

As an unphased trial, this study provides a unique opportunity to contribute to research that could shape future tax policies and smoking habits.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you've used smoking cessation medications in the past 30 days.

What prior data suggests that these tax strategies are safe for influencing smoking behavior?

A previous study showed that increasing taxes on tobacco products, as in the Harm-Reduction Tax Condition, effectively reduced smoking rates. This suggests these tax strategies can be safe and beneficial for public health by encouraging people to smoke less.

For the Modified Risk Tobacco Product Tax Condition, studies indicate that these products may claim to expose users to fewer harmful chemicals. However, they must not mislead the public. Monitoring ensures they are safe for use while reducing risks compared to traditional cigarettes.

Research also indicates that the Nicotine-Content Tax Condition, which involves reducing nicotine levels in cigarettes, helps people quit smoking. This suggests it is a safe approach as it lowers addiction levels.

Lastly, the Tobacco Parity Tax Condition, which taxes all tobacco products equally, has decreased smoking rates. This makes it a safe strategy for reducing smoking overall.

These findings suggest that all these tax conditions are generally safe and can help reduce smoking. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative tax strategies to influence smoking behavior, which is a fresh approach compared to traditional methods like nicotine replacement therapies and smoking cessation programs. The trial examines how different tax conditions, such as those targeting nicotine content or promoting harm reduction, might alter smoking habits. By testing these varied tax policies, researchers hope to discover new, effective ways to reduce smoking rates and improve public health, potentially offering more tailored solutions than existing blanket tobacco taxes.

What evidence suggests that this trial's tax strategies could be effective for influencing smoking behavior?

This trial will evaluate different tax strategies to influence smoking behavior. Research has shown that increasing taxes on tobacco products, like cigarettes, effectively reduces smoking rates. Higher prices due to taxes lead to fewer people starting to smoke and more people quitting. Participants in this trial will encounter various tax conditions, including Harm-Reduction Tax, Nicotine-Content Tax, Modified Risk Tobacco Product (MRTP) Tax, and Tobacco Parity Tax. These strategies aim to make smoking more expensive and have been shown in studies to decrease overall tobacco purchases. Various studies have demonstrated the success of these methods, suggesting they can significantly help reduce smoking habits. ^{2 6 7 8 9}

Who Is on the Research Team?

Jeff S Stein, Ph.D.

Principal Investigator

Fralin Biomedical Research Institute at VTC

Christine E Sheffer, Ph.D.

Principal Investigator

Roswell Park Comprehensive Cancer Center

Are You a Good Fit for This Trial?

This trial is for adults over 21 who smoke at least 5 cigarettes daily and use other tobacco products less than weekly. Participants must provide a breath sample showing high carbon monoxide levels, indicating recent smoking, and consent to join the study. Pregnant or breastfeeding individuals, those on smoking cessation meds recently, or with uncontrolled health issues can't participate.

Inclusion Criteria

Provide a breath carbon monoxide sample ≥ 8 ppm

Smoke at least 5 cigarettes daily

Provide informed consent

Exclusion Criteria

Be pregnant or lactating

I have used smoking cessation aids in the last 30 days.

Have plans to move out of the area during the experiment

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Experimental Condition

Participants are exposed to one control condition and one of the four tax proposals in the Experimental Tobacco Marketplace

6 trials

6 visits (in-person)

Follow-up

Participants are monitored for changes in purchasing patterns and product substitution

1 day

What Are the Treatments Tested in This Trial?

Interventions

• Harm-Reduction Tax Condition
• Market Price Condition (control)
• Modified Risk Tobacco Product (MRTP) Tax Condition
• Nicotine-Content Tax Condition
• Tobacco Parity Tax Condition

Trial Overview The study examines how four different tax proposals affect people's tobacco buying habits. These include taxes based on parity with other tobacco products, nicotine content, harm reduction potential of the product, and whether it's marketed as a modified risk tobacco product.

How Is the Trial Designed?

Group I: Cigarette smokers - Sequence 4 Experimental Treatment 5 Interventions

Exclusive cigarette smokers will be recruited and will be exposed to two control trials and each of the the four tax policy conditions in this sequence: Harm Reduction, Nicotine Content, Tobacco Parity, Modified Risk Tobacco Products.

Group II: Cigarette smokers - Sequence 3 Experimental Treatment 5 Interventions

Exclusive cigarette smokers will be recruited and will be exposed to two control trials and each of the the four tax policy conditions in this sequence: Modified Risk Tobacco Products, Harm Reduction, Nicotine Content, Tobacco Parity.

Group III: Cigarette smokers - Sequence 2 Experimental Treatment 5 Interventions

Exclusive cigarette smokers will be recruited and will be exposed to two control trials and the four tax policy conditions in this sequence: Nicotine Content, Tobacco Parity, Modified Risk Tobacco Products, Harm Reduction.

Group IV: Cigarette smokers - Sequence 1 Experimental Treatment 5 Interventions

Exclusive cigarette smokers will be recruited and will be exposed to two control trials and each of the four tax policy conditions in this sequence: Tobacco Parity, Modified Risk Tobacco Products, Harm Reduction, Nicotine Content.

Who Is Running the Clinical Trial?

Virginia Polytechnic Institute and State University

Lead Sponsor

Trials

162

Recruited

26,900+

Roswell Park Cancer Institute

Collaborator

Trials

427

Recruited

40,500+

Published Research Related to This Trial

A study involving 35 cigarette smokers showed that higher taxes on tobacco products effectively reduced overall purchasing, with the tobacco parity tax leading to decreased purchases across all tobacco products and increased purchases of medicinal nicotine.

In contrast, the harm reduction tax proposal encouraged smokers to buy more electronic nicotine delivery systems and smokeless tobacco, suggesting that taxes based on product risk could motivate smokers to switch to less harmful alternatives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Estimating the Impact of Tobacco Parity and Harm Reduction Tax Proposals Using the Experimental Tobacco Marketplace. Freitas-Lemos, R., Keith, DR., Tegge, AN., et al.[2023]

A study of 26,826 smokers found that various strategies to reduce cigarette prices, such as buying in bulk or purchasing from states with lower prices, can lower costs by 64-94 cents per pack, especially in states with higher excise taxes.

The research indicates that as cigarette excise taxes increase, the opportunities for price reductions also grow, suggesting that smokers may find ways to offset tax impacts through strategic purchasing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cigarette price minimization strategies in the United States: price reductions and responsiveness to excise taxes. Pesko, MF., Licht, AS., Kruger, JM.[2021]

In a study analyzing data from the PATH study, 29.1% of smokers reported seeing e-cigarettes with 'less harmful' claims, while only 5.1% and 5.6% noted similar claims for snus and other smokeless tobacco products, respectively.

Among smokers who noticed these 'less harmful' claims, about 24-27% expressed a likelihood of using these products in the future, indicating that such claims could potentially influence product switching among smokers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Smokers' Exposure to Perceived Modified Risk Claims for E-Cigarettes, Snus, and Smokeless Tobacco in the United States. Wackowski, OA., O'Connor, RJ., Pearson, JL.[2021]

Implementing product standards to significantly reduce nicotine content in cigarettes could help smokers quit and prevent non-smokers from starting, highlighting a potential public health strategy.

The concept of nicotine reduction can be analyzed through behavioral economics, suggesting that lowering nicotine levels increases the 'unit price' of nicotine, which may decrease smoking behavior and the overall reinforcement value of smoking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nicotine reduction as an increase in the unit price of cigarettes: a behavioral economics approach. Smith, TT., Sved, AF., Hatsukami, DK., et al.[2023]

The study of 2786 smokers in Ontario found that those who used contraband tobacco were heavier smokers and faced more barriers to quitting, indicating a higher level of addiction.

Smokers of contraband cigarettes were significantly less likely to achieve 30-day cessation both in the short term (6 months) and long term (1 year), suggesting that access to cheap, illegal tobacco undermines efforts to help people quit smoking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between use of contraband tobacco and smoking cessation outcomes: a population-based cohort study. Mecredy, GC., Diemert, LM., Callaghan, RC., et al.[2021]

Comprehensive tobacco control (CTC) measures, which include raising taxes and implementing consumer regulations, have been shown to effectively reduce smoking rates and tobacco consumption in both adults and minors.

There is a probable dose-response relationship between the extent of CTC implementation and reductions in smoking prevalence and tobacco-related mortality, indicating that more robust CTC efforts lead to greater public health benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The approach of comprehensive tobacco control in cancer prevention: elements and evidence. John, U.[2019]

The study analyzed data from 195 countries and found that higher total and specific excise taxes on tobacco are associated with smaller price differences between budget and premium cigarettes, which could help reduce smoking rates.

In 2018, the median price differential was 44.4%, with significant regional variations, indicating that implementing high specific excise taxes could effectively limit the availability of cheaper cigarettes and improve public health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cigarette taxation and price differentials in 195 countries during 2014-2018. Laverty, AA., Li, CR., Chang, KC., et al.[2023]

In a study analyzing smoking behavior in Bangladesh, it was found that higher income and higher cigarette prices both lead to an increase in smokers moving to more expensive cigarette tiers, indicating that smokers adjust their behavior based on price and income changes.

The research suggests that the current tiered tax system on cigarettes allows smokers to adapt their consumption patterns, and recommends replacing it with a uniform tax structure and increasing overall cigarette taxes to effectively reduce smoking rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Impact of Income and Taxation in a Price-Tiered Cigarette Market: findings from the ITC Bangladesh Surveys. Huq, I., Nargis, N., Lkhagvasuren, D., et al.[2019]

A significant 78% of smokers used price-minimizing strategies, such as buying from cheaper places or using coupons, which may undermine the effectiveness of cigarette excise taxes intended to reduce smoking rates.

Smokers who bought cigarettes by the carton were less likely to attempt quitting or reduce their consumption, suggesting that these strategies could hinder efforts to decrease smoking behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of price-minimizing strategies by smokers and their effects on subsequent smoking behaviors. Choi, K., Hennrikus, D., Forster, J., et al.[2012]

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]

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. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8354028/

Estimating the impact of state cigarette tax rates on ... Fully adjusted analyses show that higher state taxes are associated with lower likelihood of current cigarette smoking, daily smoking, any ...

3. 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 ...

4. rstreet.org rstreet.org/?post_type=research&p=90277

The Impact of Tobacco Harm Reduction on Smoking This paper examines how current tobacco control policies and the availability of RRPs have shaped smoking rates in the United States, Japan, and Türkiye

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/PMC8345477/

Estimating the Impact of Tobacco Parity and Harm ... This study examined the effects of the tobacco parity (ie, imposing taxes equally on all tobacco products) and the harm reduction (ie, applying taxes in ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7399441/

Impact of tobacco control interventions on smoking ... In fact, several studies reported that raising cigarette prices by increased taxes is a highly effective measure to reduce smoking among youth, young adults, ...

8. rstreet.org rstreet.org/research/tobacco-control-2-0-economic-pathways-to-better-health/

Tobacco Control 2.0: Economic Pathways to Better Health This analysis briefly explores scientific and real-world findings related to elasticity in smoking behavior (the concept that enables substation pricing models ...

9. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0246321

Associations between smoking trajectories, smoke-free laws ... Higher tax rates were associated with reduced risk of initiation and days smoked for all trajectories other than established users. Overall, ...