Tax Strategies for Smoking Behavior

Recruiting at 1 trial location

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

280 Participants Needed

Trial Summary

What is the purpose of this trial?

This study will investigate the effect of four tax proposals (i.e. Tobacco Parity, Nicotine-Content, Harm-Reduction, and Modified Risk Tobacco Product-related taxes) on tobacco product purchasing patterns.

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 data supports the effectiveness of the treatment Harm-Reduction Tax Condition, Market Price Condition (control), Modified Risk Tobacco Product (MRTP) Tax Condition, Nicotine-Content Tax Condition, Tobacco Parity Tax Condition?

Research shows that higher tobacco taxes generally lead to reduced tobacco use, as they make smoking more expensive and less attractive. Specifically, the tobacco parity tax proposal, which taxes all tobacco products equally, has been found to decrease the purchase of tobacco products and increase the purchase of medicinal nicotine, suggesting it can effectively encourage smokers to switch to less harmful alternatives. ^{1 2 3 4 5}

Is the tax strategy for smoking behavior safe for humans?

The research does not provide specific safety data for tax strategies on smoking behavior, but it suggests that tax policies can influence smoking habits and product choices, potentially reducing harm by encouraging switches to less harmful products. ^{1 4 6 7 8}

How do tax strategies for smoking behavior differ from other treatments for smoking cessation?

Tax strategies for smoking behavior are unique because they focus on using financial incentives, like taxes, to reduce smoking by making it more expensive, rather than directly targeting the smoker's behavior or addiction through medication or therapy. This approach can influence smokers to switch to less harmful products or quit altogether by altering the economic environment. ^{1 4 5 9 10}

Research Team

Warren K Bickel, Ph.D.

Principal Investigator

Fralin Biomedical Research Institute at VTC

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

Group I: Cigarette smokers - Tobacco Parity Experimental Treatment 2 Interventions

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

Group II: Cigarette smokers - Nicotine-Content Experimental Treatment 2 Interventions

Exclusive cigarette smokers will be recruited and will be exposed to the control condition and the Nicotine-Content Tax Condition described in the intervention section.

Group III: Cigarette smokers - Modified Risk Tobacco Products (MRTP) Experimental Treatment 2 Interventions

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

Group IV: Cigarette smokers - Harm-Reduction Experimental Treatment 2 Interventions

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

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

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]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Estimating the Impact of Tobacco Parity and Harm Reduction Tax Proposals Using the Experimental Tobacco Marketplace. [2023]

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

Nicotine reduction as an increase in the unit price of cigarettes: a behavioral economics approach. [2023]

3. Canada pubmed.ncbi.nlm.nih.gov

Association between use of contraband tobacco and smoking cessation outcomes: a population-based cohort study. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Use of price-minimizing strategies by smokers and their effects on subsequent smoking behaviors. [2012]

5. England pubmed.ncbi.nlm.nih.gov

The Impact of Income and Taxation in a Price-Tiered Cigarette Market: findings from the ITC Bangladesh Surveys. [2019]

6. England pubmed.ncbi.nlm.nih.gov

Smokers' Exposure to Perceived Modified Risk Claims for E-Cigarettes, Snus, and Smokeless Tobacco in the United States. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Cigarette taxation and price differentials in 195 countries during 2014-2018. [2023]

8. Switzerland pubmed.ncbi.nlm.nih.gov

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

9. England pubmed.ncbi.nlm.nih.gov

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

10. England pubmed.ncbi.nlm.nih.gov

Cigarette price minimization strategies in the United States: price reductions and responsiveness to excise taxes. [2021]