Using Search Query Surveillance to Monitor Tax Avoidance and Smoking Cessation following the United States' 2009 “SCHIP” Cigarette Tax Increase

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

吸烟者可借助互联网维持或戒除吸烟习惯。在线供应商售卖降价或免税香烟以降低吸烟成本，而健康倡导者则通过互联网宣传戒烟。本研究旨在探究，吸烟者为避税以及戒烟的互联网搜索行为，是如何受美国2009年《州儿童健康保险计划（State Children's Health Insurance Program, SCHIP）》联邦香烟消费税上调，以及另外两项州级特定税收上调所驱动的。在每一次税收上调前后两年的周期内，对比征税地区（美国全国或美国各州）居民与非征税地区（加拿大）居民的谷歌关键词搜索量。研究将搜索数据归一化至相对搜索量（Relative Search Volume, RSV）标尺：以搜索占比最高的数值标记为100，其余较低占比则根据其相较于最高占比的相对比例进行缩放。通过对比征税与非征税地区在税收上调期间及之后的均值与税收上调前的均值，来估算相对搜索量的变化。《州儿童健康保险计划》对应的香烟消费税与11.8%的搜索量变化相关（95%置信区间[95%CI]：5.7至17.9；p