Impact of four tobacco tax policies on tobacco product purchasing patterns across socioeconomic groups

SIGNIFICANCE: Understanding how integrated tobacco tax policies influence purchasing decisions across socioeconomic groups is critical to advancing tobacco control in an equitable manner in the context of the rapidly evolving tobacco and nicotine product market. Using an Experimental Tobacco Marketplace (ETM), this study examined the effects of four multitiered tax policies on tobacco purchasing among people who smoke cigarettes. Each policy used a different strategy to attain the goal of reducing cigarette purchasing among three socioeconomic groups. The policies were: tobacco parity, nicotine content, harm reduction and modified risk tobacco products. METHODS: A sample representative of the US population (N=481) was recruited from a national survey panel (Prolific). Using a within-subject/between-subject factorial design, participants completed hypothetical purchasing trials in the ETM with products priced under the four multitiered tax policies. Higher tiers equated to higher taxes. RESULTS: Higher taxes consistently reduced relative spending, while relative spending on medium-tax and no-tax tier products varied by tax proposal. The nicotine content tax policy led to the largest reduction in high-tax tier spending and the greatest shift toward no-tax products (eg, nicotine replacement). No socioeconomic differences were observed. CONCLUSIONS: These findings indicate that strategic taxation is a robust and adaptable tool for shifting tobacco purchasing. Integrated tobacco tax policies are likely to be effective at reducing consumption of the highest-risk products without a disproportionate socioeconomic impact. TRIAL REGISTRATION NUMBER: NCT06795997.