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Choi SH, Templin T. Discrete choice experiment for dyadic data collection: eliciting preferences of couple-based smoking cessation interventions. WOMEN'S HEALTH NURSING (SEOUL, KOREA) 2024; 30:9-17. [PMID: 38650323 PMCID: PMC11073556 DOI: 10.4069/whn.2024.03.08.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/25/2024]
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Bteddini D, Nakkash RT, Chalak A, Jawad M, Khader Y, Abu-Rmeileh NME, Mostafa A, Abla R, Awawda S, Salloum RG. Economic research in waterpipe tobacco smoking: reflections on data, demand, taxes, equity and health modelling. Tob Control 2023; 33:116-121. [PMID: 35902224 DOI: 10.1136/tc-2022-057383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
Economic evaluation of tobacco control policies is common in high-income settings and mainly focuses on cigarette smoking. Evidence suggests that increasing the excise tax of tobacco products is a consistently effective tool for reducing tobacco use and is an efficient mechanism for increasing government revenues. However, less research has been conducted in low/middle-income countries where other tobacco forms are common. This paper presents insights from our work on the economics of waterpipe tobacco smoking conducted in the Eastern Mediterranean Region where waterpipe smoking originated and is highly prevalent. The specific areas related to economics of waterpipe smoking considered herein are: price elasticity, taxation, government revenue, expenditure and healthcare costs. This paper aims to provide practical guidance for researchers investigating the economics of waterpipe tobacco with potential implications for other novel tobacco products. We present lessons learnt across five thematic areas: data, demand, taxes, equity and health modelling. We also highlight knowledge gaps to be addressed in future research. Research implications include designing comprehensive assessment tools that investigate heterogeneity in waterpipe smoking patterns; accounting for cross-price elasticity of demand with other tobacco products; exploring the change in waterpipe tobacco smoking in response to a tax increase and analysing the equity impact of waterpipe tobacco control interventions.
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Affiliation(s)
- Dima Bteddini
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Rima T Nakkash
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, George Mason University College of Health and Human Services, Fairfax, Virginia, USA
| | - Ali Chalak
- Department of Agriculture, American University of Beirut, Beirut, Lebanon
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Yousef Khader
- Department of Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Ruba Abla
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Sameera Awawda
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
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Choi SH, Templin T. College students' preferences for tobacco treatment: a discrete choice experiment. HEALTH EDUCATION RESEARCH 2023; 38:563-574. [PMID: 37639385 DOI: 10.1093/her/cyad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
The purpose of this study was to elicit preferences for the 'format' and 'content' of tobacco treatment among college student smokers, using an online discrete choice experiment (DCE) survey. A DCE survey, supplemented with a think-aloud method, was conducted among 54 college students who smoked combustible cigarettes and/or e-cigarettes. Conditional logistic regression models were constructed to determine optimal profiles of treatment. Cutting down nicotine rather than quitting 'cold turkey' (P < 0.001) and two-way communication (P < 0.001) were viewed as the most critical attributes for the intervention 'format'; changing behaviors rather than social groups/peers (P < 0.001) and autonomy (P < 0.001) were viewed as the most critical attributes for the intervention 'content'. Some preferences varied based on smoking subgroups. Combustible cigarette users preferred interventions with a longer time commitment (P < 0.05) and without nicotine replacement therapies (NRTs) (P < 0.001). Think-aloud data supported the DCE findings and further revealed a strong desire for cutting down nicotine and keeping social groups/peers and misconceptions regarding NRTs. Our study findings can guide tobacco treatment tailored to college students. These treatments should be tailored to specific smoker subgroups.
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Affiliation(s)
- S H Choi
- College of Nursing - Wayne State University, 5557 Cass Ave #350, Detroit, MI 48202, USA
| | - T Templin
- College of Nursing - Wayne State University, 5557 Cass Ave #350, Detroit, MI 48202, USA
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Choi SH, Templin T, Marrocco A. Development of an online discrete choice experiment to elicit preferences for tobacco treatment among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37437187 DOI: 10.1080/07448481.2023.2227715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/24/2023] [Accepted: 06/11/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To develop an online discrete choice experiment (DCE) to elicit preferences for the format and content of tobacco treatment and determine the feasibility of the survey in face-to-face online interviews among college students. PARTICIPANTS A convenience sample of 28 college students. METHODS A pilot online DCE survey with sixteen choice sets was developed. The feasibility was assessed by: 1) ease of reading the survey descriptions, 2) ease of completing the DCE survey, and 3) appropriateness of the number of choice sets. Think-aloud data were analyzed to understand decision-making processes. RESULTS All participants completed the DCE survey and reported that it was very easy to read and complete and that the number of sixteen choice sets was appropriate. Such results support the feasibility of our online DCE survey. Five decision-making strategies were identified. CONCLUSIONS An online DCE survey administered during online interviews may replace in-person interviews for college students.
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Affiliation(s)
- Seung Hee Choi
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Thomas Templin
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Anna Marrocco
- College of Nursing, Wayne State University, Detroit, Michigan, USA
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Saad RK, Maiteh A, Nakkash R, Salloum RG, Chalak A, Abu-Rmeileh NME, Khader Y, Al Nsour M. Monitoring and Combating Waterpipe Tobacco Smoking Through Surveillance and Taxation. JMIR Public Health Surveill 2023; 9:e40177. [PMID: 36951907 PMCID: PMC10132023 DOI: 10.2196/40177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Waterpipe tobacco smoking (WTS) is a traditional tobacco use method that originated in the Eastern Mediterranean Region (EMR) and has resurged in recent decades. WTS rates in the EMR are the highest worldwide, especially among youth, exceeding cigarette-smoking rates in select jurisdictions. Despite its documented harm, the growing prevalence of WTS has been met with a poor regulatory response globally. At the epicenter of the WTS epidemic, countries in the EMR are in urgent need of effective tobacco control strategies that consider the particularities of WTS. A roundtable session, titled "Monitoring and Combating WTS Through Taxation and the Global Tobacco Surveillance System (GTSS)," was held as part of the 7th Eastern Mediterranean Public Health Network's regional conference. The session provided an overview of evidence to date about WTS policy control, the taxation of WTS, volumetric choice experiments for tobacco control research, and monitoring WTS patterns and control policies among adults and youth through the GTSS. The session highlighted the need to update the regulation of WTS in the current global tobacco control policy frameworks and the need for developing tailored, evidence-based, and WTS-specific regulations to complement current tobacco control policy frameworks. Raising taxes to increase the price of tobacco products is the single most effective tobacco control measure, and these taxes can fund expanded government health programs. The effectiveness of taxation can be measured via volumetric choice experiments, which allow for the estimation of a complete set of own-price and cross-price elasticities that are instrumental for fiscal policy simulations. Finally, the surveillance of WTS (for example, through the GTSS) is critical to informing policy and decision makers. The Global Youth Tobacco Survey (GYTS) and Global Adult Tobacco Survey (GATS) are 2 GTSS products that provide nationally representative data among students aged 13-15 years and persons ≥15 years, respectively.
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Affiliation(s)
- Randa K Saad
- Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Adna Maiteh
- Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Florida, FL, United States
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Occupied Palestinian Territory
| | - Yousef Khader
- Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohannad Al Nsour
- Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan
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Williams G, Kinchin I. The application of discrete choice experiments eliciting young peoples' preferences for healthcare: a systematic literature review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022:10.1007/s10198-022-01528-9. [PMID: 36169764 DOI: 10.1007/s10198-022-01528-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Understanding young people's preferences for healthcare is critical for reducing the negative effect of undesirable choices. This review aims to synthesise the evidence obtained from discrete choice experiments (DCEs) eliciting young people's preferences for healthcare interventions and service deliveries, specifically, to (1) examine the methodology, including a selection of attributes and levels, experimental design, estimation procedure and validity; (2) evaluate similarities, differences and rigour of designs to the general population DCEs; and, (3) compare the DCEs' application to the seven health priority areas defined by the World Health Organisation (WHO). METHODS A systematic review searching Medline, EconLIT, PsychINFO, Scopus, and Web of Science was performed up until May 2021. INCLUSION CRITERIA a DCE, eliciting young peoples' preferences (10-24 years of age), on a healthcare-related topic defined by WHO, peer-reviewed, full-text available in English. A bespoke checklist was used to assess the methodological quality of the included studies. RESULTS Eighteen DCE studies were included in the review, exploring interventions and service in sexual and reproductive health (n = 9; 50%), smoking cessation (n = 4; 22%), mental health (n = 1), nutrition (n = 1), unintentional injuries (n = 1), vaccination against severe but rare diseases (n = 1); and diabetes (n = 1). Compared to the general population, DCEs eliciting young people's preferences had a high proportion of monetary measures and a smaller number of choices per respondent with the overwhelming number of surveys using fractional factorial design. The majority of studies were of moderate quality (50-75% of the criteria met). CONCLUSIONS While identified DCEs touched on most health priority areas, the scope was limited. The conduct and reporting of DCEs with young people could be improved by including the state-of-the-art design, estimation procedures and analysis.
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Affiliation(s)
- Galina Williams
- School of Business, Accounting and Law, CQUniversity, Brisbane, Australia.
| | - Irina Kinchin
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Romani M, Nakkash R, Jawhar S, Salloum RG. Implementation of a free smoking-cessation program in a Lebanese academic medical center. Tob Induc Dis 2021; 18:75. [PMID: 33408599 PMCID: PMC7780928 DOI: 10.18332/tid/125916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/03/2020] [Accepted: 07/31/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite the exceptionally high prevalence of tobacco use in Lebanon, few cessation programs exist. The American University of Beirut (AUB) developed one of the first smoking-cessation programs in the country in 2015, and the program became free-of-charge to patients in 2018. The program offers initial visit(s) with a primary care provider, in-person and/or telephone counseling, acupuncture, and medications. METHODS We assessed patient characteristics, treatments used, and patient outcomes in the first year of implementing the free smoking-cessation program, compared to the original program. We compared 87 smokers who initiated treatment in the free program with 47 patients in the original program. RESULTS At baseline, smokers in the free program were younger, smoked fewer cigarettes per day, and had lower CO levels than smokers in the original program. At 1 month follow-up, 72.9% were abstinent in the free program, compared with 42.2% in the original program (p<0.001). Smokers who had ≥2 primary care visits and those who had ≥1 acupuncture visits had higher rates of abstinence at 1 month and those who were prescribed bupropion had higher rates of abstinence at 12 months. CONCLUSIONS Implementation of the free smoking cessation program demonstrates preliminary efficacy, with telephone support offering potential for scalability.
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Affiliation(s)
- Maya Romani
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sarah Jawhar
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ramzi G Salloum
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, United States
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Katz DA, Hamlin C, Vander Weg MW, Grant KM, Stewart Steffensmeier KR, Paez M, Hawley ST, Gaeth G. Veterans' preferences for tobacco treatment in primary care: A discrete choice experiment. PATIENT EDUCATION AND COUNSELING 2020; 103:652-660. [PMID: 31629558 DOI: 10.1016/j.pec.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate US veterans' preferences for smoking cessation counseling and pharmacotherapy. METHODS A discrete choice experiment (DCE) was conducted in 123 Veterans Health Administration primary care outpatients who planned to quit smoking within 6 months. Key attributes of tobacco cessation treatment were based on literature review and expert opinion. We used a hierarchical Bayesian approach with a logit model to estimate the part-worth utility of each attribute level and used latent class logit models to explore preference heterogeneity. RESULTS In the aggregate, participants valued counseling options with the following attributes: higher quit rate at 1 year, emphasis on autonomy, familiarity of the counselor, counselor's communication skills, and inclusion of printed materials on smoking cessation. Participants valued pharmacotherapy options with the following attributes: higher quit rate at 1 year, lower risk of physical side effects, zero copayment, monthly check-in calls, and less weight gain. Latent class analysis revealed distinct clusters of patients with a unique preference "phenotype." CONCLUSIONS Veterans have distinct preferences for attributes of cessation counseling and pharmacotherapy. PRACTICE IMPLICATIONS Identifying patients' preferences provides an opportunity for clinicians to offer tailored treatment options that better engage veterans in their own care and boost adherence to guideline-recommended counseling and pharmacotherapy.
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Affiliation(s)
- David A Katz
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA; Department of Medicine, University of Iowa, Iowa City, IA, USA; Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
| | - Christine Hamlin
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Mark W Vander Weg
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA; Department of Medicine, University of Iowa, Iowa City, IA, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System and the Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kenda R Stewart Steffensmeier
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Monica Paez
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Sarah T Hawley
- Ann Arbor Veterans Administration (VA) Healthcare System, University of Michigan, Ann Arbor, MI, USA; Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Gary Gaeth
- Tippie School of Business, University of Iowa, Iowa City, IA, USA
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Salloum RG, Nakkash R, Abu-Rmeileh NME, Hamadeh RR, Darawad MW, Kheirallah KA, Al-Farsi Y, Yusufali A, Thomas J, Mostafa A, Salama M, El Kadi L, Alzyoud S, Al-Sheyab N, Thrasher JF. Individual-level determinants of waterpipe smoking demand in four Eastern-Mediterranean countries. Health Promot Int 2019; 34:1157-1166. [PMID: 30412234 DOI: 10.1093/heapro/day084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The prevalence of waterpipe tobacco smoking in the Eastern Mediterranean Region is at alarmingly high levels, especially among young people. The objective of this research was to evaluate the preferences of young adult waterpipe smokers with respect to potential individual-level determinants of waterpipe smoking using discrete choice experiment methodology. Participants were young adult university students (18-29 years) who were ever waterpipe smokers, recruited from universities across four Eastern Mediterranean countries: Jordan, Oman, Palestine and the United Arab Emirates. The Internet-based discrete choice experiment, with 6 × 3 × 2 block design, evaluated preferences for choices of waterpipe smoking sessions, presented on hypothetical waterpipe café menus. Participants evaluated nine choice sets, each with five fruit-flavored options, a tobacco flavored option (non-flavored), and an opt-out option. Choices also varied based on nicotine content (0.0% vs. 0.05% vs. 0.5%) and price (low vs. high). Participants were randomized to receive menus with either a pictorial + text health-warning message or no message (between-subjects attribute). Multinomial logit regression models evaluated the influence of these attributes on waterpipe smoking choices. Across all four samples (n = 1859), participants preferred fruit-flavored varieties to tobacco flavor, lower nicotine content and lower prices. Exposure to the health warning did not significantly predict likelihood to opt-out. Flavor accounted for 81.4% of waterpipe smoking decisions. Limiting the use of fruit flavors in waterpipe tobacco, in addition to accurate nicotine content labeling and higher pricing may be effective at curbing the demand for waterpipe smoking among young adults.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, USA
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon
| | - Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, PO Box 14, Birzeit, Palestine
| | - Randah R Hamadeh
- College of Medicine and Medical Sciences, Arabian Gulf University, Road 2904, 293 Manama, Bahrain
| | - Muhammad W Darawad
- School of Nursing, The University of Jordan, Queen Rania Street, 11942 Amman, Jordan
| | - Khalid A Kheirallah
- Department of Public Health, Community Medicine, Jordan University of Science and Technology, PO Box 3030, 22110 Irbid, Jordan
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 35, 123, Al Khod, Muscat, Oman
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Health Authority and Dubai Medical College, 35th Street, PO Box 2017, Dubai, United Arab Emirates
| | - Justin Thomas
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassiya, 11566 Cairo, Egypt
| | - Mohamed Salama
- Medical Experimental Research Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Lama El Kadi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon
| | - Sukaina Alzyoud
- Department of Community and Mental Health Nursing, Faculty of Nursing, Hashemite University, PO Box 330127, 13133 Zarqa, Jordan
| | - Nihaya Al-Sheyab
- Department of Maternal and Child Nursing, Jordan University of Science and Technology, PO Box 3030, 22110 Irbid, Jordan
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, 29208 Columbia, SC, USA
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Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete Choice Experiments in Health Economics: Past, Present and Future. PHARMACOECONOMICS 2019; 37:201-226. [PMID: 30392040 PMCID: PMC6386055 DOI: 10.1007/s40273-018-0734-2] [Citation(s) in RCA: 402] [Impact Index Per Article: 80.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. METHODS A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. RESULTS Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. CONCLUSIONS The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
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Affiliation(s)
- Vikas Soekhai
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University, Raleigh, NC USA
| | - Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Regmi K, Kaphle D, Timilsina S, Tuha NAA. Application of Discrete-Choice Experiment Methods in Tobacco Control: A Systematic Review. PHARMACOECONOMICS - OPEN 2018; 2:5-17. [PMID: 29464666 PMCID: PMC5820233 DOI: 10.1007/s41669-017-0025-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Economic evidence relating to tobacco control is generally derived from the cost effectiveness of smoking-cessation programs or the economic impact of tobacco-induced disease, based on revealed-preference data. However, empirical estimates from stated-preference data on tobacco users' preferences, smoking behaviour and smoking cessation aids using analytical techniques such as discrete-choice experiments (DCEs) could be important for policy decision making in tobacco control. OBJECTIVES Our objective was to review the practice and utility of DCE methodology across nicotine- and tobacco-related issues, particularly smoking and smoking-cessation behaviour, anti-smoking policies and preferences for smoking-cessation aids. METHODS We searched the PubMed, MEDLINE and ECONLIT databases for full-text original research articles on tobacco-related issues published between January 2000 and April 2016 that used a DCE method. We summarised the evidence and methodological characteristics of DCEs according to Lancsar and Louviere, 2008. RESULTS Our review of the 12 eligible studies showed that DCE methodology was used to elicit smoker preferences and to evaluate tobacco-control policies. The majority of the studies were published in the last 5 years. The areas of application were smoking cessation, smoking behaviour, electronic cigarette use, water-pipe smoking and tobacco packaging. Monetary attributes were the most influential attributes in all studies. The design of the DCEs varied. CONCLUSION DCE studies of tobacco-related issues were methodologically consistent with guidelines proposed for conducting health-related DCEs.
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Affiliation(s)
- Kabindra Regmi
- Faculty of Health Science, PAPRSB Institute of Health Science, University Brunei Darussalam, Gadong, BE1410 Brunei Darussalam
- Centre for Innovative Research in Public Health, Pokhara, Nepal
| | - Dinesh Kaphle
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sabina Timilsina
- Centre for Innovative Research in Public Health, Pokhara, Nepal
- Faculty of Medicine, Center for Tropical Medicine, Gadjah Mada University, Gedung PAU UGM, Yogyakarta, 55281 Indonesia
| | - Nik Annie Afiqah Tuha
- Faculty of Health Science, PAPRSB Institute of Health Science, University Brunei Darussalam, Gadong, BE1410 Brunei Darussalam
- Department of Primary Care and Public Health, Faculty of Public Health, Imperial College London, London, UK
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Salloum RG, Shenkman EA, Louviere JJ, Chambers DA. Application of discrete choice experiments to enhance stakeholder engagement as a strategy for advancing implementation: a systematic review. Implement Sci 2017; 12:140. [PMID: 29169397 PMCID: PMC5701380 DOI: 10.1186/s13012-017-0675-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/15/2017] [Indexed: 01/11/2023] Open
Abstract
Background One of the key strategies to successful implementation of effective health-related interventions is targeting improvements in stakeholder engagement. The discrete choice experiment (DCE) is a stated preference technique for eliciting individual preferences over hypothetical alternative scenarios that is increasingly being used in health-related applications. DCEs are a dynamic approach to systematically measure health preferences which can be applied in enhancing stakeholder engagement. However, a knowledge gap exists in characterizing the extent to which DCEs are used in implementation science. Methods We conducted a systematic literature search (up to December 2016) of the English literature to identify and describe the use of DCEs in engaging stakeholders as an implementation strategy. We searched the following electronic databases: MEDLINE, Econlit, PsychINFO, and the CINAHL using mesh terms. Studies were categorized according to application type, stakeholder(s), healthcare setting, and implementation outcome. Results Seventy-five publications were selected for analysis in this systematic review. Studies were categorized by application type: (1) characterizing demand for therapies and treatment technologies (n = 32), (2) comparing implementation strategies (n = 22), (3) incentivizing workforce participation (n = 11), and (4) prioritizing interventions (n = 10). Stakeholders included providers (n = 27), patients (n = 25), caregivers (n = 5), and administrators (n = 2). The remaining studies (n = 16) engaged multiple stakeholders (i.e., combination of patients, caregivers, providers, and/or administrators). The following implementation outcomes were discussed: acceptability (n = 75), appropriateness (n = 34), adoption (n = 19), feasibility (n = 16), and fidelity (n = 3). Conclusions The number of DCE studies engaging stakeholders as an implementation strategy has been increasing over the past decade. As DCEs are more widely used as a healthcare assessment tool, there is a wide range of applications for them in stakeholder engagement. The DCE approach could serve as a tool for engaging stakeholders in implementation science. Electronic supplementary material The online version of this article (10.1186/s13012-017-0675-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Jordan J Louviere
- Institute for Choice, School of Marketing, University of South Australia, Adelaide, SA, Australia
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Salloum RG, Maziak W, Hammond D, Nakkash R, Islam F, Cheng X, Thrasher JF. Eliciting preferences for waterpipe tobacco smoking using a discrete choice experiment: implications for product regulation. BMJ Open 2015; 5:e009497. [PMID: 26353876 PMCID: PMC4567671 DOI: 10.1136/bmjopen-2015-009497] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Waterpipe smoking is highly prevalent among university students, and has been increasing in popularity despite mounting evidence showing it is harmful to health. The aim of this study was to measure preferences for waterpipe smoking and determine which product characteristics are most important to smokers. SETTING A large university in the Southeastern USA. PARTICIPANTS Adult waterpipe smokers attending the university (N=367). DESIGN Participants completed an Internet-based discrete choice experiment to reveal their preferences for, and trade-offs between, the attributes of hypothetical waterpipe smoking sessions. Participants were presented with waterpipe lounge menus, each with three fruit-flavoured options and one tobacco flavoured option, in addition to an opt out option. Nicotine content and price were provided for each choice. Participants were randomised to either receive menus with a text-only health-warning message or no message. OUTCOME MEASURES Multinomial and nested logit models were used to estimate the impact on consumer choice of attributes and between-subject assignment of health warnings respectively. RESULTS On average, participants preferred fruit-flavoured varieties to tobacco flavour. They were averse to options labelled with higher nicotine content. Females and non-smokers of cigarettes were more likely than their counterparts to prefer flavoured and nicotine-free varieties. Participants exposed to a health warning were more likely to opt out. CONCLUSIONS Fruit-flavoured tobacco and lower nicotine content labels, two strategies widely used by the industry, increase the demand for waterpipe smoking among young adults. Waterpipe-specific regulation should limit the availability of flavoured waterpipe tobacco and require accurate labelling of constituents. Waterpipe-specific tobacco control regulation, along with research to inform policy, is required to curb this emerging public health threat.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Policy, Institute for Child Health Policy, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Wasim Maziak
- Department of Epidemiology, Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Syrian Center for Tobacco Studies, Aleppo, Syria
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Farahnaz Islam
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xi Cheng
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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