Nicotine reduction as an increase in the unit price of cigarettes: A behavioral economics approach☆,☆☆
Introduction
The Family Smoking Prevention and Tobacco Control Act gives the FDA the authority to regulate cigarettes (US Congress, 2009). Included in the act is the authority to reduce the content of nicotine to any non-zero level, a strategy that has been suggested for reducing the prevalence of smoking (Benowitz and Henningfield, 1994, Benowitz and Henningfield, 2013, Us Department Of Health And Human Services, 2014). Similar standards could be set by countries party to the Framework Convention on Tobacco Control; Article 9 allows for guidelines on the regulation of the content and emissions of tobacco products. Recent studies support nicotine reduction as a promising approach by showing that substantial reductions in nicotine content can result in reduced toxicant exposure and, in some cases, a reduction in smoking behavior and dependence (Benowitz et al., 2007, Benowitz et al., 2012, Donny et al., 2007, Hatsukami et al., 2010a, Hatsukami et al., 2010b). Notably, required reductions in the nicotine content in cigarettes would differ from existing reduced yield cigarettes which yield less nicotine when smoked by a machine, but less so when smoked by humans (Hoffmann and Hoffmann, 2001).
Behavioral economics borrows principles from the field of microeconomics to describe how consumption of a reinforcer changes as the unit price of that reinforcer is manipulated (unit price = cost/reinforcer magnitude) (See Hursh and Roma, 2013 for a recent review and tutorial of the approach). A behavioral economics framework asserts that consumption of a reinforcer is related to the unit price of that reinforcer and the unit price of concurrently available reinforcers. Manipulations in unit price often take place through increases in cost (i.e., the numerator) such as increases in monetary value, effort, or time required obtaining the reinforcer (Hursh and Roma, 2013). An example of this approach is taxation, which has been reliably shown to drive down consumption (Chaloupka and Warner, 1999). Importantly, a decrease in the magnitude of the reinforcer (i.e., the denominator) should be functionally equivalent to an increase in cost (Bickel et al., 1990) and may represent an underutilized approach to tobacco control. The relationship between cost and reinforcer magnitude is rather intuitive on the surface—if the price of a pack of cigarettes is doubled, the change in cigarette consumption should be the same as if the number of cigarettes in a pack was cut in half, because the price per cigarette (i.e., unit price) has been changed in the same way.
Decades of research suggest that the primary reason people smoke is to obtain nicotine (Stolerman and Jarvis, 1995, Us Department Of Health And Human Services, 1988). Hence, a reduction in nicotine content may be thought of as an increase in the unit price of nicotine. This perspective allows for the application of behavioral economics approaches to be applied to research questions related to potential product standards for nicotine (Donny et al., 2012). The purpose of the present paper is to describe how a behavioral economics framework might be used to advance research related to nicotine regulation, and discuss the implications of such a framework.
Section snippets
How will nicotine reduction affect nicotine consumption and smoking behavior?
Behavioral economics uses demand curves to characterize changes in the consumption of a reinforcer as a function of unit price (Hursh and Silberberg, 2008). An example of a demand curve and a curve showing corresponding changes in behavior can be seen in Fig. 1. Assuming people smoke to obtain nicotine, a demand curve can be generated by using nicotine content as reinforcer magnitude to calculate unit price. However, changes in nicotine content may not translate easily into changes in nicotine
How is a nicotine reduction policy related to the consumption of other reinforcers?
The effect of unit price of concurrently available reinforcers on consumption is termed cross-price elasticity (see Hursh and Roma, 2013 for a review). Cross-price elasticity is important for a nicotine-reduction policy because as nicotine is reduced, consumption of other reinforcers (e.g., other tobacco products, other drugs of abuse) could change. Conversely, the unit price of each of these reinforcers may affect the impact of a nicotine reduction policy. Cross-price demand curves, which plot
Is nicotine content related to the reinforcer value of cigarettes?
A decrease in nicotine content may only be thought of as an increase in unit price if reinforcement value is closely related to nicotine content. Many theories of tobacco dependence place importance on nicotine as the primary source of value for smoking behavior, as either a positive or a negative reinforcer. In rodent self-administration experiments, rats will make more responses to earn higher doses of nicotine (Chaudhri et al., 2007, Donny et al., 1999), indicating that the value of nicotine
Conclusions
An FDA policy reducing the nicotine content in cigarettes may dramatically improve public health. A behavioral economics framework provides several tools for researchers interested in a nicotine reduction policy. Demand curves and cross-price demand curves can be used to characterize changes in consumption of these reinforcers as a function of unit price. Research in which the unit price of cigarettes is manipulated through increases in cost may be useful for making predictions regarding
Conflict of interest
Dr. Hatsukami was funded by Nabi Biopharmaceuticals and NIDA to be a site for a nicotine immunotherapy trial. Tracy Smith, Dr. Sved, and Dr. Donny have no conflicts to report.
Funding
This publication was supported by the National Institute on Drug Abuse and FDA Center for Tobacco Products (CTP) (U54 DA031659 awarded to E.C.D.). The funding source had no other role other than financial support. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.
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Cited by (0)
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A previous draft of this manuscript served as a specialty paper presented by the first author in partial fulfillment of a doctoral degree. The authors would like to thank committee members Dr. Michael Sayette and Dr. Saul Shiffman for their comments on that version.
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This publication was supported by the National Institute on Drug Abuse and FDA Center for Tobacco Products (CTP) (U54 DA031659 awarded to E.C.D. & D.K.H.). The funding source had no other role other than financial support. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration. Funding for Tracy Smith was supported by the National Institute on Drug Abuse (F31 DA037643).