Behavioral economic tobacco demand in relation to cigarette consumption and nicotine dependence: a meta-analysis of cross-sectional relationships

Abstract

Background and aims: A cigarette purchase task (CPT) aims to characterize individual variation in the reinforcing value of tobacco. This meta-analysis estimated the associations between cigarette demand, tobacco consumption and nicotine dependence using this task.

Design: A meta-analysis of cross-sectional studies identified by PubMed and PsycINFO databases was conducted. Fixed- and random-effects models were used. The study also examined the model used to derive elasticity of demand (exponential or exponentiated) as a potential moderator. Publication bias was assessed using 'fail-safe N', Begg-Mazumdar test, Egger's test, Tweedie's trim-and-fill approach and meta-regression of publication year with effect size.

Setting: Studies from any setting that reported coefficient correlations on the tested associations.

Participants: Daily cigarette users (i.e. 5 to 38 cigarettes per day; n = 7649).

Measurements: Cigarette consumption, nicotine dependence and five tobacco demand indicators: intensity (i.e. consumption at no cost), elasticity (i.e. sensitivity to rises in costs), O_max (maximum expenditure), P_max (i.e. price at which consumption becomes elastic) and breakpoint (i.e. price at which consumption ceases).

Findings: Twenty-three studies met inclusion criteria. All the CPT indices were significantly correlated with smoking behavior (rs = 0.044-0.572, Ps = 0.012-10^-8 ). Medium-to-large effect size associations were present for intensity, O_max, and elasticity, whereas small effects were obtained for breakpoint and P_max . Evidence of a moderating effect of the different elasticity modeling approaches was not present. There was limited evidence of publication bias.

Conclusions: All five demand indices derived from the cigarette purchase task by (CPT) were robustly associated with cigarette consumption and tobacco dependence. Of the demand indices, maximum expenditure, intensity and elasticity exhibited the largest magnitude associations.

Keywords: Behavioral economics; cigarette; demand; meta-analysis; nicotine; purchase task; reinforcing value; smoking; tobacco.