TCORS 2.0: Center for the Assessment of Tobacco Regulations (CAsToR)

Pilot + Feasibility

2019 Funding Cycle Awardees

View other award years: 202220212020

Please note: Listing describes appointments and affiliations at the time of award. Please check our Trainees page for current appointments and affiliations.

Title: “The effect of IQOS introduction on cigarette sales: the role of prices in product substitution”
PI: Michal Stoklosa, Graduate Student at University of Cape Town
Abstract and accomplishments +
Michal Stoklosa
Michal StoklosaUniversity of Cape Town
Abstract
Introduction: A recent study finds that introduction of a new heated tobacco product, IQOS, reduced cigarette sales in Japan (Stoklosa et al. 2019). However, the role product prices play in this substitution from cigarettes to IQOS have never been independently examined. In October 2018, Japan introduced excise tax on IQOS and increased excise rate on cigarettes, which resulted in higher prices of both products and changed their price ratio. Aims: To compare patterns of IQOS and cigarette use before and after the tax increase in October 2018 in Japan to better understand how the use of the two products depends on the relative price of the products, controlling for other likely covariates. To estimate the cross-price elasticities of cigarettes and IQOS to learn how the demands for the two products are related. Methods: The study uses 2014 to 2019 monthly retailer panel, shop-scanner data from 11 of Japan’s 12 geographical regions and a method involving a system of equations (incorporating seemingly unrelated regression) to estimate price elasticities of cigarettes and IQOS cigarettes and their cross-price elasticities. The models control for household income and seasonality. Anticipated Results: The estimated own-price elasticity for IQOS shows the extent to which IQOS use is responsive to price increases, such as through taxation. The estimated cross-price elasticity indicates the extent to which price increase on one product type makes users switch to the other product type. Implications: Reporting the patterns of product substitution and examining the role product prices play in this substitution are all important information for policymakers and public health proponents as they consider how to adapt existing tobacco control policies to accommodate these new products. The study will assist in better policy formation, including in jurisdictions where these products are just entering or will enter the marketplace, such as the US.
Accomplishments
January 15, 2021: In October 2018, Japan introduced a new HTP tax category and increased the excise rate on cigarettes. We examine the impact of the new tax and the corresponding price increase on the use of the two products. We use 2015 to 2019 monthly shop-scanner data from 11 of Japan’s 12 geographical regions (n=435). The method involves panel data analysis including through seemingly unrelated regressions (SUR). We estimate the own- and cross- price elasticity of demand for HTPs and cigarettes, which capture the products’ sensitivity to prices. We control for likely covariates, including income, a time trend, and the seasonality of sales. Our results find that after the 2018 tax increase, the price increased across all HTP brands. The weight-based tax favored hybrid HTP technology. To cushion the users against the HTP tax, Japan Tobacco increased the HTP price by less than the tax increase while Philip Morris International introduced a less-expensive HTP brand. The estimated price elasticity for cigarettes and HTPs combined is -0.8. Cross-price effects are positive in all models, indicating that when the price of one product rises, use of the other product increases. Our findings affirm that HTP use is highly responsive to price increases, such as through taxation. Our findings also suggest that HTPs are more responsive to price changes than cigarettes, and that HTPs and cigarettes are substitutes. The study results can help to improve policy development in jurisdictions where HTP taxation is being considered.
Title: “Game Theoretic Modelling of Tobacco Industry Responses to a Proposed Ban on the Sale of Menthol Flavored Cigarettes”
PI: Dr. Michael Hayashi, Post-doctoral Research Fellow at University of Michigan
Abstract and accomplishments +
Dr. Michael Hayashi
Dr. Michael HayashiUniversity of Michigan
Abstract
Introduction: At every step along the regulatory pathway, the FDA meets resistance when promulgating rules that the tobacco industry perceives as harmful to its interests. Moreover, the industry responded to past regulation by adapting its business practices to ensure ongoing profitability. Therefore, it is critical for regulators and tobacco control researchers to understand how the tobacco industry might respond to new regulatory actions, particularly in the context of a potential ban on the sale of menthol cigarettes. We will apply a systems modeling approach using game theory and population simulations to address this issue. Aims:
  • Aim 1:Investigate optimal methods for the FDA to minimize smoking prevalence and health disparities by implementing aban on the sale of menthol flavored cigarettes using game theoretic modeling to include and analyze the role of tobacco industry actors.
    • Sub-Aim 1.1:Construct a game theoretic model of menthol cigarette regulation to represent the strategic interactions between key actors including the FDA, cigarette companies, and consumers.
    • Sub-Aim 1.2:Analyze the model in 1.1 to determine the best policy options available to the FDA to implement menthol regulations that minimize the health burden and disparities of menthol cigarettes given the strategic responses of the tobacco industry.
Methods: We will develop a game theoretic model of the tobacco industry and its role within the regulatory process. Our model will consider three types of actors: the FDA, tobacco industry, and consumers. In this model, the FDA and tobacco industry actors engage in strategic negotiation that determines a regulatory policy outcome. Consumer smoking behavior is then projected using simulation methods to estimate the impact of the game. Anticipated Results: A Nash equilibrium of the regulation game comprises (1) a proposed rule, (2) optimal industry reactions to both the proposed rule and potential revisions, (3) optimal potential revisions to potential industry reactions and court rulings, (4) cigarette production consistent with rules that emerge from the regulatory stage (5) average smoking/cessation/initiation. Our objective will be to identify equilibrium paths that lead tothe promulgation ofsuccessful regulations. Implications: Understanding the behavior of the industry will enable public health outcomes from proposed tobacco control policies to better match the intentions of regulators. In particular, successful regulation of menthol cigarettes should reduce health disparities in mortality and morbidity between racial groups.
Accomplishments
January 31, 2021: Based on Nash equilibrium analysis of two game theoretic models developed for this project, we found that low costs relative to potential revenue losses for the tobacco industry as well as mixed stakeholder signals for the FDA likely prevented menthol regulations from progressing in 2013. We also found that differential market dominance between menthol cigarettes and ecigarettes could incentivize a tobacco company dominant in e-cigarettes but not menthol to support menthol cigarette regulations if they believe enough consumers would switch to ecigarettes following a ban. Together, these results suggest that modeling industry and other key regulatory actors could provide insight into conditions that would enable or inhibit successful tobacco regulations. We have presented our work at SRNT 2020, as well as at the November CAsToR webinar. Two manuscripts are currently in preparation.

Selected pilot project

Title: “Tobacco Product Marketing Regulatory Policies and Disparities Due to Minorities’ Diminished Returns”
PI: Dr. Shervin Assari, Assistant Professor at Charles R Drew University of Medicine and Science
Abstract and accomplishments +
Dr. Shervin Assari
Dr. Shervin AssariCharles R Drew University of Medicine and Science
Abstract
Introduction: In line with a phenomenon called Minorities’ Diminished Returns (MDRs), more than expected tobacco use is found in high socioeconomic Black and Hispanic individuals. Predatory marketing strategies (e.g. discounts, coupons, and flavoring) that may disproportionately target predominantly Black and Hispanic communities may have a role in explaining such MDRs. Aims: The current study aims to explore race/ethnicity by SES interactions on tobacco use as well as tobacco promotion exposure among Americans. Methods: This is a secondary analysis of waves 1-3 data of the Population Assessment of Tobacco and Health (PATH) (public data). PATH has recruited and followed 49,000 individuals 12+ years old individuals for changes in tobacco use over time. A large sample size, a national representative sample, a longitudinal design, and extensive data on multiple tobacco products such as Electronic Nicotine Delivery Systems are among advantages of using the PATH data. We will use regression models to investigate race and ethnic variations in the effects of SES indicators on tobacco use and tobacco promotion exposure. Anticipated Results: We expect SES indicators to show weaker protective effects on tobacco use and tobacco promotion exposure for Black and Hispanic compared to non-Hispanic Whites (MDRs), however, we expect stronger MDRs for Blacks than Hispanics, educational attainment than income, and males than females. Implications: The results will help us understand the role the predatory marketing policies and practices play in shaping racial, ethnic, and SES disparities in tobacco use. The results will particularly highlight the role of restriction of predatory marketing and advertising in preventing disproportionately higher risk of tobacco use among high SES Black and Hispanic individuals, relative to their high SES White counterparts.
Accomplishments
February 12, 2021: Most of the past work in tobacco use disparities has traditionally focused on mediational models, suggesting that a third factor such as socioeconomic status (SES), stress, or place is why marginalization status is associated with a higher tobacco use burden. Built on our past empirical and review studies, we advanced our understanding of Minorities’ Diminished Returns (MDRs) as an explanation for disparities in tobacco use. According to MDRs, disparities are in part due to the “less than expected” effects of SES on tobacco use in marginalized populations. Our study had three Aims: (1) To test whether SES's protective effects would be smaller for marginalized than non-marginalized people. (2) To test whether tobacco promotion (point-of-sale advertisement) mediates such MDRs, and (3) To test whether these effects differ for product type, gender/sex, and age. We conducted a secondary analysis of the following data: 1) National Health Interview Survey (NHIS), 2) the Health and Retirement Survey (HRS), 3) the Health Information National Trends Survey (HINTS), 4) the Population Assessment of Tobacco and Health Study, and 5) Adolescent Brain Cognitive Development (ABCD) study. SES was the independent variable, use of various tobacco products was the outcome, and marginalization status (race, ethnicity, immigration, and lesbian, gay, and bisexual [LGB] status) was the moderator. Regression was used for data analysis. We found that these MDRs: 1) hold for various tobacco products such as cigarettes, e-cig, and hookah, 2) hold across SES indicators such as education, income, and employment, 3) hold for Black, Hispanic, Asian American, LGB, and immigrant people. 4) hold for youth, adults, and older adults, 5) hold across all studies tested, 6) hold for prevalence and incidence of tobacco use, 7) hold for first-hand and second-hand exposure, 8) hold for tobacco-induced chronic diseases such as asthma, COPD, and heart disease, 9) hold for some of the neurocognitive correlates of tobacco use such as attention, inhibitory control, reward sensitivity, fun-seeking, cognitive control, and emotion regulation, and 10) are mainly due to structural processes such as segregation. One example is higher than expected exposure to tobacco ads in high SES people of color. Disparities in tobacco use are not all due to SES gaps and diminished gains that follow high SES for marginalized populations, which draw our attention to tobacco use disparities across the full spectrum of SES. Addressing tobacco inequalities and disparities requires frameworks that acknowledge middle-class people of color's high risk of tobacco use.
Title: “Electronic Cigarettes: Projecting Behavioral and Clinical Outcomes”
PI: Dr. Krishna Reddy, Assistant Professor at Massachusetts’ General Hospital
Abstract and accomplishments +
Dr. Krishna Reddy
Dr. Krishna ReddyMassachusetts’ General Hospital
Abstract
Introduction: The net public health impact of electronic cigarettes (e-cigs) will depend on: 1) how much they help current smokers to stop smoking tobacco cigarettes; 2) how much they promote adolescent and young adult non-smokers to smoke tobacco cigarettes; 3) whether e-cigs themselves confer health risks. In advance of longer-term trial and observational data, we will use a microsimulation model to make projections. Aims: 1) To estimate possible changes in life expectancy resulting from use of e-cigs in the US, accounting for potential harms and benefits including: a) in adolescents and young adults, initiation of cigarette smoking; b) in adult smokers, switching from cigarettes to e-cigs. 2) To project the life expectancy impact on adolescents and young adults of banning flavored e-cigs. Methods: This proposal leverages our new Simulating Tobacco and Nicotine Outcomes and Policy (STOP) microsimulation model of tobacco- and nicotine-related behaviors and clinical outcomes. While the STOP model currently includes smoking behaviors, it does not yet specifically include e-cig or dual product use. We will add structural detail to the model to specifically examine e-cigs and their potential impact on cigarette smoking behaviors and health outcomes. We will parameterize the model with existing and emerging data on e-cig use and cigarette smoking. Where data are uncertain, we will perform sensitivity analysis. Anticipated Results: We anticipate demonstrating the thresholds for e-cig uptake among adolescents and young adults, for e-cig-related smoking cessation among adults, and for e-cig-related mortality risks at which the net public health impact in terms of life-years becomes either positive or negative. We will project how banning flavored e-cigs could affect e-cig and cigarette smoking uptake among adolescents and young adults. Implications: Our findings can provide useful information to public health officials and policymakers regarding the potential downstream effects of e-cig use and regulations.
Accomplishments
October 08, 2021: In August 2021, Dr. Reddy received an Innovation Award (PDF) from the American Lung Association for the project, “The Public Health Impact of Electronic Cigarette Policies.” This grant will support research that began during Dr. Reddy's CAsToR pilot project period. July 15, 2021: Dr. Reddy was the lead author on a short original research article based on his pilot project research. The paper, entitled “Respiratory Symptom Incidence among People Using Electronic Cigarettes, Combustible Tobacco, or Both” was published in the American Journal of Respiratory and Critical Care Medicine and is available here. December 05, 2020: The net public health impact of electronic cigarettes (e-cigs) will depend on the balance of three factors: 1) how much they help current smokers to stop smoking tobacco; 2) how much they promote adolescent and young adult non-smokers to develop nicotine dependence and transition to tobacco; 3) how much e-cigs themselves confer health risks. Data are emerging about these factors, but long-term effects are unknown. Simulation modeling offers a valuable method of addressing policy-relevant questions that cannot be readily answered via conventional trials or observational cohorts. This proposal leveraged our new Simulation of Tobacco and Nicotine Outcomes and Policy (STOP) microsimulation model of tobacco- and nicotine-related behaviors and clinical outcomes. This project aimed to add structural and parameter detail to the STOP model to specifically examine e-cigs and their potential impact on tobacco smoking behaviors and health outcomes.The study performance included model design and implementation, model parameterization, and epidemiologic analysis. We designed, specified, programmed, and debugged new e-cig components of the STOP model. Meanwhile, we looked to data from the Population Assessment of Tobacco and Health (PATH) Study to begin to parameterize the model with behavioral transitions between various states of tobacco smoking and e-cig use. We also performed epidemiologic analysis using PATH data, specifically examining the association between e-cig use, tobacco smoking, dual use, and respiratory symptoms.Our results include a new e-cig model structure and the development of preliminary multistate models of behavioral transitions. We have also found, from PATH data, that dual use of e-cigs and tobacco smoking is associated with significantly higher incidence of respiratory symptoms compared with use of either product alone. Next steps include further development of multistate models of behavioral transitions and model parameterization. We will use the model to project changes in health outcomes associated with various e-cig regulatory policies.We are grateful for support from CAsToR, the National Cancer Institute of the National Institutes of Health, and the FDA Center for Tobacco Products.
Title: “Impact of new product standards for JUUL among dual JUUL/combusted cigarette users”
PI: Dr. Lauren Pacek, Assistant Professor at Duke University School of Medicine
Abstract and accomplishments +
Dr. Lauren Pacek
Dr. Lauren PacekDuke University School of Medicine
Abstract
Introduction: Despite some data derived from hypothetical tasks, little experimental research exists to evaluate how potential tobacco regulations might impact the use of other tobacco products in addition to the targeted product. It is critical to anticipate how potential restrictions on the e-cigarette market may impact e-cigarette and other tobacco product—such as combusted cigarette—use. Aims: The present study aims to evaluate: 1) topography and product appeal; and 2) demand for JUUL e-cigarettes that vary in flavor (e.g., tobacco vs. preferred) as compared to participants’ usual brand combusted cigarette. Methods: Participants will undergo 2 experimental visits during which they will have access to 2 controlled puffing volume apparatuses (CPVAs). One CPVA will always be loaded with their usual brand cigarette and the other will be loaded with a JUUL pod; in one session, the pod will be their preferred flavor and in the other, the pod will be tobacco flavor. In each session, we will measure: 1) topography and product appeal; and 2) relative reinforcement (via a concurrent choice task) of the provided combusted cigarette/JUUL products. Anticipated Results: We hypothesize that: 1) relative to preferred flavor JUUL or combusted cigarettes, participants will take smaller puffs of tobacco-flavored JUUL and will rate it as less appealing; and 2) limiting JUUL to tobacco flavor will increase expended effort for cigarettes as compared to when JUUL are available in a preferred flavor. Implications: This work will provide the FDA with actionable information regarding the impact of a product standard limiting JUUL to tobacco-only flavor on the appeal and use of combusted cigarettes. This work is highly responsive to FDA research priorities by evaluating how “changes in tobacco product characteristics (such as flavors…) impact on tobacco use behaviors including… dual/poly use, transition to non-flavored products, and …” (Addiction Priority Area).
Accomplishments
September 22, 2021: This project was, unfortunately, not completed due to challenges related to the COVID-19 pandemic. However, it has served as a springboard for other potential research projects, including a recently submitted R01 application.
Title: “Understanding how personal networks shape young adults’ e-cigarette outcome expectancies and perceptions of FDA anti-vaping messages”
PI: Joshua Barker, Roy H. Park Doctoral Fellow at University of North Carolina – Chapel Hill
Abstract and accomplishments +
Joshua Barker
Joshua BarkerUniversity of North Carolina – Chapel Hill
Abstract
Introduction: E-cigarette use among young adults has grown significantly in recent years. However, there is a noticeable gap in federal anti-vaping messages targeting young adults. Previous research suggests personal networks, or people with whom we interact, may influence beliefs about addictive behaviors and that these baseline beliefs likely impact our reaction to persuasive messages. Aims: 1.) Examine how young adults’ personal network composition and structure affect participants’ baseline outcome expectancies [OE] about e-cigarettes (i.e. expected health and social outcomes associated with e-cigarette use). 2.) Examine how young adults’ personal network composition and structure affect their perceptions of anti-vaping messages. 3.) Examine how personal networks, perceived message effectiveness, and baseline outcome expectancies predict changes in behavioral intentions. Methods: Cross-sectional, randomized controlled study of 2,000 American young adults (18-25) recruited from Qualtrics. Respondents will complete egocentric (personal) network questions detailing relevant discussion networks (e.g., with whom they discuss health matters), provide baseline e-cigarette OE, use/susceptibility, intentions and then be randomized to view either Real Cost or control (e.g., CDC e-cig facts) messages and respond to them. Following the last message, respondents will provide immediate post-exposure intentions/susceptibility and e-cigarette risk beliefs. Anticipated Results: We believe respondents with greater numbers of e-cigarette users in their and closer ties with e-cigarette users in their network will: 1.) anticipate fewer negative outcomes about e-cigarette use at baseline, 2.) have greater negative perceptions of anti-vaping advertisements, and 3.) exhibit fewer changes to risk beliefs, susceptibility, or quit intentions following ad exposure. Implications: This study will provide key data about the impact of Real Cost ads on young adults’ risk beliefs and intentions and the influence of personal networks on initial effectiveness of anti-vaping advertisements. These data will help inform modeling for targeting future campaigns as well as methods for evaluating post-hoc campaign effectiveness.
Accomplishments
December 07, 2020: American young adults are among the cohorts most at risk of using electronic cigarettes. Despite the prevalence of use, there have thus far been no dedicated national campaigns aimed at curbing young adult vaping. This grant funded a dissertation that sought to examine how the composition and structure of a young adult’s social network as well as their baseline beliefs about e-cigarettes were associated with both young adult susceptibility and vaping frequency as well as their reactions to anti-vaping advertisements. Data for this dissertation comes from over 2,000 young adults recruited from online survey panels. Egocentric network data, baseline usage, susceptibility, quit intentions and vaping outcome expectancies were collected before respondents viewed one of two anti-vaping advertisement conditions and answered perceived message effectiveness items. Finally, post-exposure quit intentions, susceptibility, and vaping risk beliefs were assessed. Results indicate strong support for the associations between both the composition (attitudes, behaviors) and the structure (density, size) of young adults’ social networks with vaping outcome expectancies, usage, and perceptions of anti-vaping advertisements. Theoretical and empirical implications for message testing and anti-vaping campaigns were published in the dissertation and will be leveraged into upcoming journal and conference submissions.

View other award years: 202220212020