Forecasting the health returns of tobacco tax proposals

Scientists with Virginia Tech’s Fralin Biomedical Research Institute at VTC are leading a five-year, $3.5 million study to predict the impact of tobacco taxes on health.

Cigarette smoking is the leading cause of preventable death in the United States, causing more than 480,000 deaths each year, according to the Centers for Disease Control and Prevention. 

“Taxes are one of the most effective ways to change behavior – they make people think about their choices, including their choice to use tobacco,” said Warren Bickel, a professor at the Fralin Biomedical Research Institute and director of the institute’s Addiction Recovery Research Center.

Funded by the National Cancer Institute of the National Institutes of Health, Bickel’s research project will forecast the impact of tobacco tax proposals in a complex experimental marketplace that continually changes with the introduction of new products, such as low-nicotine cigarettes or electronic cigarettes.

The work has potential to deliver research-based health policy guidance for new tobacco regulations as well as evaluate the health consequences of people’s economic choices.

“Taxes can help people achieve better health by discouraging them not to smoke. If you make the product more expensive, people will use less of it. They can also leverage people to move from the most harmful tobacco products to the least harmful,” said Bickel, who is also the director of the institute’s Center for Health Behaviors Research.

He will take tobacco-related health disparities into account by investigating socioeconomic factors.

“People with low incomes have a higher prevalence of smoking, and disproportionate tax policies could have far-reaching direct and unintended effects,” said Bickel, who is also a professor of psychology in the Virginia Tech College of Science. 

To get clear answers, Bickel’s approach involves the Experimental Tobacco Marketplace, an invention of the Addiction Recovery Research Center. Participants have an account and buy tobacco products to reflect their typical purchasing. Co-investigators at the Fralin Biomedical Research Institute working on the project with Bickel include Jeff Stein and Allison Tegge.

The marketplace places the mix of products, prices, and specific regulations under experimental control for researchers to estimate policy impact in real-world circumstances. 

In this environment, researchers can forecast the impact and health equity of tax proposals, including a proposal that equally levies taxes across all tobacco products, as well as others that issue tax based on a product’s nicotine content, potential for harm, or whether it has received a modified-risk designation from the Food and Drug Administration. 

“We can implement policies in the experimental tobacco marketplace and provide information about the impacts on people’s tobacco purchasing,” said Bickel. “For example, if lawmakers or regulators restrict access to one product versus another, will it result in smokers making less healthy or more healthy choices? It is an ideal resource to investigate the harm-reduction potential of low nicotine cigarettes and alternative nicotine products.”