The effect of potential electronic nicotine delivery system regulations on nicotine product selection

Abstract

Aims To estimate the effect of potential regulations of electronic nicotine delivery systems (ENDS) among adult smokers, including increasing taxes, reducing flavour availability, and adding warning labels communicating various levels of risk. Design We performed a discrete choice experiment (DCE) among a national sample of 1,200 adult smokers. We examined heterogeneity in policy responses by age, cigarette quitting interest, and current ENDS use. Our experiment overlapped January, 2015 by design, providing exogenous variation in cigarette quitting interest from New Year resolutions. Setting KnowledgePanel, an online panel of recruited respondents. Participants 1,200 adult smokers from the United States. Measurements Hypothetical purchase choice of cigarettes, nicotine replacement therapy, and a disposable ENDS. Findings Increasing ENDS prices from $3 to $6 was associated with a 13.6 percentage point reduction in ENDS selection (p<0.001). Restricting flavour availability in ENDS to tobacco and menthol was associated with a 2.1 percentage point reduction in ENDS selection (p<0.001). The proposed FDA warning label was associated with a 1.1 percentage point reduction in ENDS selection (p<0.05), and the MarkTen warning label with a 5.1 percentage point reduction (p<0.001). We estimated an ENDS price elasticity of −1.8 (p<0.001) among adult smokers. Statistically significant interaction terms (p<0.001) imply that price responsiveness was higher among adult smokers 18–24 years of age, smokers who have vaped over the last month, and smokers with above the median quitting interest. Young adult smokers were 3.7 percentage points more likely to choose ENDS when multiple flavours were available than older adults (p<0.001). Young adult smokers and those with above the median cigarette quitting interest were also more likely to reduce cigarette selection and increase ENDS selection in January, 2015 (p<0.001), potentially in response to New Year’s resolutions to quit smoking. Conclusions Increased taxes, a proposed US Food and Drug Administration warning label for electronic nicotine delivery systems (ENDS) and a more severe warning label may discourage adult smokers from switching to ENDS. Reducing the availability of flavours may reduce ENDS use by young adult smokers.

The impact of flavour, device type and warning messages on youth preferences for electronic nicotine delivery systems: evidence from an online discrete choice experiment

“…This finding is consistent with a recent focus group study showing that participants considered MarkTen warnings to be stronger that a nicotine statement 49. It also corroborates recent evidence that young adult smokers, compared with older adult smokers, are less likely to choose ENDS when exposed to strong health warning messages 47. The combined evidence suggests that the warning message required by the FDA may deter youth uptake of ENDS, but stronger warnings could have a greater impact.…”

Effect of Flavors and Modified Risk Messages on E-cigarette Abuse Liability

“…17 Further, the presence of a modified risk warning label was not associated with differences in choice of e-cigarettes over other tobacco products. 17 In a study using another behavioral economic measure of demand, willingness to pay, smokers valued the availability of flavors and the harm reduction potential of e-cigarettes, and would pay significantly less for an e-cigarette without these attributes. 21 Collectively, these examinations and the present studies demonstrate that both flavors and modified risk messaging can affect smokers’ abuse liability for e-cigarettes.…”

“…16 Young adult cigarette smokers respond more to e-cigarette flavor availability than do older smokers, suggesting a role for flavors in attracting youth. 17 However, otherwise, there is a dearth of experimental research addressing how e-cigarette flavor affects e-cigarette use or abuse liability.…”

Combustible cigarettes cost less to use than e-cigarettes: global evidence and tax policy implications

“…If we are to believe that e-cigarettes and combustible cigarettes are substitute products, any price advantage given to combustible cigarettes is likely to increase smoking relative to what would be the case if e-cigarettes had the price advantage 26. If e-cigarettes are complementary products to combustible cigarettes, then we would expect that raising the price of the less expensive product (combustible cigarettes) would still decrease consumption of both products.…”