Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
Department of Statistics, Virginia Tech, Blacksburg, VA, USA.
Nicotine Tob Res. 2024 May 31;26(Supplement_2):S103-S111. doi: 10.1093/ntr/ntad070.
Cigarette smoking accounts for >30% of the socioeconomic gap in life expectancy. Flavored restrictions claim to promote equity; however, no previous studies have compared the effect of cigarette and e-cigarette flavor restrictions among individuals who smoke with lower and higher socioeconomic status (SES).
In a between-group within-subject design, individuals with lower (n = 155) and higher (n = 125) SES completed hypothetical purchasing trials in the experimental tobacco marketplace (ETM). Conditions were presented in a 2 × 2 factorial design (cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted) with increasing cigarette prices across trials.
Results show (1) SES differences in cigarette, e-cigarette, and NRT purchases under unrestricted policies, with lower SES showing higher cigarette demand and lower e-cigarette and NRT substitution than higher SES, (2) cigarette restrictions decreased cigarette and increased NRT purchases among lower SES, but no significant changes among higher SES, (3) decreased SES differences in cigarette demand under cigarette restrictions, but persistence under e-cigarette restrictions or their combination, (4) persistence of SES differences in e-cigarette purchases when all restrictions were enforced, and (5) waning of SES differences in NRT purchasing under all restrictions.
Flavor restrictions differentially affected individuals based on SES. Within-group comparisons demonstrated restrictions significantly impacted lower SES, but not higher SES. Between-group comparisons showed SES differences in cigarette purchasing decreased under cigarette restrictions, but persisted under e-cigarette-restrictions or their combination. Additionally, SES differences in NRT substitution decreased under flavor restrictions. These findings highlight the utility of the ETM to investigate SES disparities.
With increasing trends of socioeconomic differences in smoking prevalence and cessation rates, smoking-related health disparities are expected to continue to widen. Restricting menthol flavor in cigarettes while enhancing the availability and affordability of NRT have the potential to alleviate SES disparities in tobacco use, therefore, positively impacting health equity. However, this effect may depend on flavor availability in other tobacco products.
吸烟导致预期寿命的社会经济差距超过 30%。调味限制声称旨在促进公平；然而，以前没有研究比较过在社会经济地位（SES）较低和较高的吸烟者中，香烟和电子烟口味限制的效果。
在一项分组内个体间设计中，SES 较低（n=155）和较高（n=125）的个体在实验烟草市场（ETM）中完成了假设的购买试验。条件以 2×2 因子设计呈现（香烟口味限制或不限制，电子烟口味限制或不限制），随着试验的进行，香烟价格逐渐增加。
结果表明：（1）在无限制政策下，SES 在香烟、电子烟和 NRT 购买方面存在差异，SES 较低的个体表现出更高的香烟需求，而 NRT 替代电子烟的需求较低，而 SES 较高的个体则相反；（2）香烟限制降低了 SES 较低个体的香烟和增加了 NRT 购买，但 SES 较高个体没有显著变化；（3）在香烟限制下，SES 差异对香烟需求的影响降低，但在电子烟限制或其组合下仍然存在；（4）在实施所有限制时，SES 差异在电子烟购买方面仍然存在；（5）在所有限制下，NRT 购买的 SES 差异逐渐减弱。
调味限制根据 SES 对个体产生了不同的影响。组内比较表明，限制对 SES 较低的个体有显著影响，但对 SES 较高的个体没有影响。组间比较表明，在香烟限制下，SES 差异在香烟购买方面减少，但在电子烟限制或其组合下仍然存在。此外，在调味限制下，NRT 替代的 SES 差异减少。这些发现突出了 ETM 在调查 SES 差异方面的效用。
随着社会经济差异在吸烟率和戒烟率方面的趋势增加，与吸烟相关的健康差距预计将继续扩大。限制香烟中的薄荷醇味道，同时增加尼古丁替代疗法的可及性和可负担性，有可能减轻烟草使用方面的 SES 差异，从而对健康公平产生积极影响。然而，这种效果可能取决于其他烟草产品中的口味可用性。
