Abstract
Smokers can use the web to continue or quit their habit. Online vendors sell reduced or tax-free cigarettes lowering smoking costs, while health advocates use the web to promote cessation. We examined how smokers' tax avoidance and smoking cessation Internet search queries were motivated by the United States' (US) 2009 State Children's Health Insurance Program (SCHIP) federal cigarette excise tax increase and two other state specific tax increases. Google keyword searches among residents in a taxed geography (US or US state) were compared to an untaxed geography (Canada) for two years around each tax increase. Search data were normalized to a relative search volume (RSV) scale, where the highest search proportion was labeled 100 with lesser proportions scaled by how they relatively compared to the highest proportion. Changes in RSV were estimated by comparing means during and after the tax increase to means before the tax increase, across taxed and untaxed geographies. The SCHIP tax was associated with an 11.8% (95% confidence interval [95%CI], 5.7 to 17.9; p<.001) immediate increase in cessation searches; however, searches quickly abated and approximated differences from pre-tax levels in Canada during the months after the tax. Tax avoidance searches increased 27.9% (95%CI, 15.9 to 39.9; p<.001) and 5.3% (95%CI, 3.6 to 7.1; p<.001) during and in the months after the tax compared to Canada, respectively, suggesting avoidance is the more pronounced and durable response. Trends were similar for state-specific tax increases but suggest strong interactive processes across taxes. When the SCHIP tax followed Florida's tax, versus not, it promoted more cessation and avoidance searches. Efforts to combat tax avoidance and increase cessation may be enhanced by using interventions targeted and tailored to smokers' searches. Search query surveillance is a valuable real-time, free and public method, that may be generalized to other behavioral, biological, informational or psychological outcomes manifested online.
Highlights
About 70% of the 46 million smokers in the United States (US) desire to quit, with 3% of all smokers quitting and staying quit each year [1]
The $0.39–1.01 federal State Children’s Health Insurance Program (SCHIP) tax increase was associated with immediate sharp peaks for smoking cessation and tax avoidance searches in the US indicative of anticipation of and responses to the tax (Figure 1A)
In the US, smoking cessation relative search volume (RSV) increased by a factor of 11.8% (95% confidence interval [95%CI], 5.7 to 17.9; p,.001) of the highest RSV comparing differences of differences from the pre-period, weeks 14 through 52 in 2008, with compared to an untaxed geography (Canada)
Summary
About 70% of the 46 million smokers in the United States (US) desire to quit, with 3% of all smokers quitting and staying quit each year [1]. Large decreases in smoking prevalence [2] have, in part, been achieved through stronger tobacco control policies [3;4]. Typically via excise tax increases, may be the most effective tobacco control measure [7;8]. Higher prices increase smoking cessation, prevent smoking initiation, and reduce the quantity smoked among continuing smokers [9]. Tax avoidance undermines the public health effectiveness of cigarette taxes [10]. Smokers seek out Internet cigarette vendors because their prices undercut brick and mortar retailers by selling from duty-free zones, low tax jurisdictions, or sovereign Indian reservations [11,12,13,14]
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