Buckell John, Marti Joachim, Sindelar Jody L
School of Public Health, Yale University, New Haven, Connecticut, USA.
Institute of Social and Preventive Medicine (IUMSP), CHUV, Université de Lausanne, Lausanne, Switzerland.
Tob Control. 2018 May 28. doi: 10.1136/tobaccocontrol-2017-054165.
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.
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.
A sample of 2031 adult smokers and recent quitters was recruited to complete an online survey and DCE.
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%).
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.
提供关于替代口味禁令对成年吸烟者和近期戒烟者对香烟和电子烟的偏好及需求影响的与政策相关的估计。
采用最佳 - 最佳离散选择实验（DCE）来引出吸烟者和近期戒烟者对香烟和电子烟的口味、价格、健康影响及尼古丁水平的偏好。研究了烟草产品的选择以及一个退出选项。一个高效的设计产生了36个选择集。估计了扩展的逻辑选择模型。通过在估计模型中限制口味系数来模拟口味禁令。
招募了2031名成年吸烟者和近期戒烟者的样本，以完成一项在线调查和DCE。
当前吸烟者和近期戒烟者平均而言更喜欢香烟和薄荷醇香烟而非有口味的电子烟。然而，年轻成年人（18 - 25岁）、种族/族裔以及受过高等教育的受访者存在显著的偏好异质性。我们的预测表明，禁止薄荷醇香烟将使香烟选择的减少幅度最大（-5.2%），但同时电子烟使用会增加（3.8%）。相比之下，禁止电子烟口味但允许香烟中有薄荷醇，将导致香烟选择的增加幅度最大（8.3%），而电子烟使用会下降（-11.1%）。禁止两种产品中除烟草味之外的所有口味，会使“退出”的比例增加最多（5.2%），但也会增加香烟选择（2.7%）并减少电子烟选择（-7.9%）。
仅禁止有口味的电子烟可能会增加吸烟者对香烟的选择，而香烟是获取尼古丁更有害的方式，而仅禁止薄荷醇香烟可能在减少香烟选择方面更有效。禁止两种产品中的所有口味可能会降低吸烟/吸电子烟率，但香烟的使用仍会高于现状。政策制定者应根据他们对两种产品潜在健康影响的立场，利用这些结果来指导口味禁令的选择。
