AVA Synopsis: The authors sought to understand the implications of banning flavors in combustible cigarette and tobacco products.
The authors utilized a discrete choice experiment (DCE) which asked respondents to “make a series of choices across products described using a set of attributes and levels.” Within these choices, the authors can understand the importance of the choices. The authors asked respondents to “choose their preferred option” from four products including flavor, health impact, nicotine levels, and pricing.
The study used a sample of 2,031 U.S. adult smokers and recent quitters between the ages of 18 and 64 years old. Using the DCE, the authors estimated that banning menthol cigarettes “would produce the greatest reduction in the choice of cigarettes” and lead to an increase in e-cigarette use. A ban on flavored e-cigarettes, but no ban on menthol products, would “result in the greatest increase in the selection of cigarettes.” The authors found that a ban flavors in both combustible cigarettes and e-cigarettes “would increase ‘opting-out’ the most” but would lead to an increase in cigarette use and a decrease in e-cigarette uses.
Implications: The study provides more evidence into the role of flavors in e-cigarettes and vapor products. As a tobacco harm reduction product that is at least 95 percent safer than smoking, policymakers should refrain from policies that would decrease use of e-cigarettes. This study provides evidence that flavor bans results in reduced use of e-cigarettes and increased use of combustible cigarette products.
ABSTRACT
Objectives: To provide the policy-relevant estimates of impacts of alternative flavour bans on preferences and demand for cigarettes and e-cigarettes in adult smokers and recent quitters.
Methods: A best–best discrete choice experiment (DCE) is used to elicit smokers’ and recent quitters’ preferences for flavours, price, health impact and nicotine level in cigarettes and e-cigarettes. Choice of tobacco products and an opt-out option were examined. An efficient design yielded 36 choice sets. Exploded logit choice models were estimated. Flavour bans are modelled by restricting flavour coefficients in the estimated model.
Setting and participants: A sample of 2031 adult smokers and recent quitters was recruited to complete an online survey and DCE.
Results: Current smokers and recent quitters, on average, prefer cigarettes and menthol cigarettes over flavoured e-cigarettes. However, there is substantial preference heterogeneity by younger adults (ages 18–25), race/ethnicity and respondents with higher education. Our predictions suggest that a ban on menthol cigarettes would produce the greatest reduction in the choice of cigarettes (−5.2%), but with an accompanying increase in e-cigarettes use (3.8%). In contrast, banning flavours in e-cigarettes, while allowing menthol in cigarettes would result in the greatest increase in the selection of cigarettes (8.3%), and a decline in the use of e-cigarettes (−11.1%). A ban on all flavours, but tobacco in both products would increase ‘opting-out’ the most (5.2%) but would also increase choice of cigarettes (2.7%) and decrease choice of e-cigarettes (−7.9%).
Conclusions: A ban on flavoured e-cigarettes alone would likely increase the choice of cigarettes in smokers, arguably the more harmful way of obtaining nicotine, whereas a ban on menthol cigarettes alone would likely be more effective in reducing the choice of cigarettes. A ban on all flavours in both products would likely reduce the smoking/vaping rates, but the use of cigarettes would be higher than in the status quo. Policy-makers should use these results to guide the choice of flavour bans in light of their stance on the potential health impacts both products.
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