The impact of ENDS tax policies on the consumption of ENDS and cigarettes

Project Abstract The marked increase in ENDS use in the last decade has prompted a range of government actions, including the imposition of ENDS excise taxes by some states and localities. Currently, 23 states, DC, and several local jurisdictions have ENDS excise taxes in place. While these taxes may prevent youth from ENDS use, it remains unclear whether the imposition and strength of ENDS taxes enacted at the state and local levels have kept the cost incentive for adult smokers to switch to ENDS. As a 2020 Cochrane review concluded that there is moderate evidence supporting ENDS effectiveness in helping smokers to quit, it is increasingly important to understand how ENDS taxes in a tobacco tax system that targets both ENDS and cigarettes impact the choices between the two, particularly among adult smokers who use both and are possibly in transition to quitting smoking. The growing complexity of product characteristics of ENDS further complicates the design of effective tax policies. Unlike cigarette taxes based simply on unit (per pack), ENDS taxes can be based on volume (per ml), price (per value), and nicotine (per mg), and choices of tax bases will lead to differential tax burdens by ENDS systems (pods vs. disposables. vs. tank systems) that could further impact product choices, satisfaction, and tobacco use trajectories. The broad goal of this project is to fill the evidence gap by quantifying the impacts of ENDS tax policies, including the imposition and strength, on tobacco consumption and choices (e.g., disposables vs. pods; ENDS vs. cigarettes) among adult ENDS users, further exploring how differential tax burdens due to different tax bases impact product choices. We propose to conduct volumetric choice experiments (VCEs) among adults who dual-use cigarettes and ENDS (age 18+; N=400) to examine Aim 1 (the impact of a tobacco tax system on choices between ENDS and cigarettes and the consumption of each), and among adults who use ENDS and do not smoke cigarettes (age 18+; N=400) to examine Aim 2 (the impact of ENDS taxes on ENDS product choice and consumption). We will innovatively adopt VCEs which expand on the common discrete choice experiments (DCEs) used in tobacco research and have the following advantages: 1) measure quantities instead of binary choices; 2) flexibly model the relationship between products by allowing for both complementarity (e.g., ENDS use increases cigarette smoking) and substitution (ENDS use decreases smoking); and 3) explicitly model the impacts of device taxes (prices) and refillable taxes (prices) on behaviors. Our study is highly significant and will inform federal, state, and local ENDS tax policies by providing evidence on the effectiveness of ENDS taxes on reducing tobacco use and harms among adult ENDS users, which addresses NCI tobacco research priorities for the next decade, including understanding the complexity of current tobacco products (#4) and identifying innovative policy to further reduce tobacco use (# 7).