The Effect of Potential Electronic Nicotine Delivery System Regulations on Nicotine Product Selection

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.

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