1
|
Yang Y, Lindblom EN, Salloum RG, Ward KD. Impact of flavours, device, nicotine levels and price on adult e-cigarette users' tobacco and nicotine product choices. Tob Control 2023; 32:e23-e30. [PMID: 34301836 DOI: 10.1136/tobaccocontrol-2021-056599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/09/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION To understand the impact of e-cigarette devices, flavours, nicotine levels and prices on adult e-cigarette users' choices among closed-system and open-system e-cigarettes, cigarettes and heated tobacco products (HTPs). METHODS Online discrete choice experiments were conducted among adult (≥18 years) e-cigarette users (n=2642) in August 2020. Conditional logit regressions were used to assess the relative impact of product attributes and the interactions between product attributes and user characteristics, with stratified analyses to examine differences by smoking status and primarily used e-cigarette device and flavour. RESULTS On average, participants preferred non-tobacco and non-menthol flavours most, preferred open-system over closed-system e-cigarettes and preferred regular nicotine level over low nicotine level. However, the preference varied by demographics, smoking status and the primarily used e-cigarette device and flavour. The differences in preference among products/devices were larger than the difference among flavours or nicotine levels. Participants who primarily used closed-system e-cigarettes exhibited similar preferences for closed-system and open-system e-cigarettes, but those who primarily used open-system e-cigarettes preferred much more open-system over closed-system e-cigarettes. HTP was the least preferred product, much lower than cigarettes in general, but participants living in states where IQOS is being sold had similar preferences to cigarettes and HTPs. CONCLUSIONS People are unlikely to switch to another product/device because of the restriction of flavour or nicotine level. If non-tobacco and non-menthol flavours were banned from open-system e-cigarettes, users may switch to menthol flavour e-cigarettes. Intervention strategies should be tailored to specific groups.
Collapse
Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| |
Collapse
|
2
|
Alqahtani MM, Massey ZB, Fairman RT, Churchill V, Ashley DL, Popova L. General and Device-Specific Reasons for ENDS Use: A Qualitative Study with Adult ENDS Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116822. [PMID: 35682417 PMCID: PMC9180821 DOI: 10.3390/ijerph19116822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND A scientific consensus on the public health impact of electronic nicotine delivery systems (ENDS) remains elusive. This is partly due to the wide variation in product characteristics often lumped together under one category. Research is needed to better understand what ENDS device type characteristics motivate their use by adults. METHODS Nine focus groups of 32 current ENDS users who were 18+ years old, had used ENDS in the previous 30 days, and had been using ENDS for more than two months were held either in person or online between February and June 2020. RESULTS Participants' reasons for their choice of ENDS characteristics included both general, applying to all ENDS products, and specific, relating to particular ENDS devices. Health benefits and the lack of offensive odor were commonly identified as important reasons for using ENDS in general. Flavor and product discreteness were both general and device-specific determinants of ENDS use. Conversely, nicotine delivery, cloud size, battery properties, aesthetics, ease of use, and cost were device-specific drivers of participants' choice. CONCLUSIONS The reasons that adults choose to use ENDS are complex and sometimes related to both ENDS as a category and as specific ENDS product types. Regulations and public communication campaigns should reflect their ultimate objective and consider both general and specific motivations when attempting to achieve public health objectives.
Collapse
Affiliation(s)
- Mohammed M. Alqahtani
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Zachary B. Massey
- School of Journalism, University of Missouri, Columbia, MO 65211, USA;
| | - Robert T. Fairman
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA; (R.T.F.); (V.C.); (D.L.A.)
| | - Victoria Churchill
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA; (R.T.F.); (V.C.); (D.L.A.)
| | - David L. Ashley
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA; (R.T.F.); (V.C.); (D.L.A.)
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA; (R.T.F.); (V.C.); (D.L.A.)
- Correspondence:
| |
Collapse
|
3
|
Enyioha C, Boynton MH, Ranney LM, Byron MJ, Goldstein AO, Kistler CE. Preferences for different features of ENDS products by tobacco product use: a latent class analysis. Subst Abuse Treat Prev Policy 2022; 17:18. [PMID: 35260177 PMCID: PMC8906001 DOI: 10.1186/s13011-022-00448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND From a public health perspective, electronic nicotine delivery devices (ENDS) use may be beneficial for some populations (e.g., smokers who fully switch to ENDS) but detrimental for others (e.g., nonsmokers). Understanding the importance placed on different ENDS product features by user groups can guide interventions and regulations. METHODS Participants were US adults who had used ENDS at least once and from a convenience sample drawn from a market research software in 2016. Participants chose between 9 different ENDS product features (harms of use, general effects of use, use as a cessation aid, initial purchase price, monthly cost, nicotine content, flavor availability, device design, and modifiability). A latent class analysis (LCA) identified subgroups of feature preferences and examined differences between groups by socio-demographics and tobacco product use. RESULTS Of the 636 participants, 81% were White, the median age was 42, and 65% were current cigarette smokers. The LCA identified a 4-class solution as the most appropriate model: (1) people with high nicotine dependence who preferred ENDS similar to combustible cigarettes, (2) people with moderate tobacco use who were interested in low nicotine ENDS (3) people who use ENDS and combustible tobacco who preferred lower price and flavored ENDS products, and (4) people who used ENDS predominantly, without a strong preference for any of the features presented. CONCLUSIONS Tobacco use classes were associated with differences in preferences for ENDS features. These findings can inform regulations to reduce ENDS use among specific groups of people who use ENDS products.
Collapse
Affiliation(s)
- Chineme Enyioha
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Marcella H Boynton
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Justin Byron
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christine E Kistler
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
4
|
Ashley DL, Spears CA, Weaver SR, Huang J, Eriksen MP. E-cigarettes: How can they help smokers quit without addicting a new generation? Prev Med 2020; 140:106145. [PMID: 32473270 PMCID: PMC7680279 DOI: 10.1016/j.ypmed.2020.106145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/01/2020] [Accepted: 05/24/2020] [Indexed: 12/17/2022]
Abstract
The dramatic increase in youth use of electronic nicotine delivery systems (ENDS; e.g., e-cigarettes) in the United States has focused regulatory efforts to address this concern while still encouraging smokers to switch completely to lower risk products or quit all tobacco product use. Increases in the minimum age for purchase of all tobacco products and changes in enforcement policy for ENDS have been recently enacted in an effort to address the youth vaping epidemic. Since all ENDS marketed after February 15, 2007 will be required to meet the "appropriate for the protection of public health" standard for marketing authorization of new products, ENDS manufacturers will have to demonstrate, in part, that their products help lessen the adverse impact on youth use. Some, such as disallowing flavors other than tobacco or menthol or limiting nicotine delivery, may help reduce youth use but could also inhibit smokers from quitting smoking. Other approaches, including reducing the high-tech appearance and discreteness of ENDS, discontinuing use of coupons and two-for-one type price incentives for ENDS, limiting retail sales of these products to adult-only facilities, and incorporating technological innovations such as biometrics or geofencing into ENDS, may help manufacturers demonstrate that marketing of their products would help reduce youth use of ENDS and lessen the epidemic, while still assuring adult smokers have access to products that encourage discontinuing combusted product use.
Collapse
Affiliation(s)
- David L Ashley
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America; Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America.
| | - Claire Adams Spears
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America
| | - Scott R Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America; Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America
| | - Jidong Huang
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America
| | - Michael P Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States of America; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States of America
| |
Collapse
|
5
|
Abstract
Electronic cigarettes (e-cigarettes) are electronic devices designed to vaporize chemical compounds. The device is made up of a mouthpiece, liquid tank, a heating element, and a battery. E-cigarette use may pose health risks in the form of cardiovascular and respiratory diseases. These health risks have implications to not only the primary user, but the aerosols can also cause secondhand and thirdhand injuries to others in the vicinity. Acute lung injury may also be associated with the use of e-cigarettes, but the underlying cause remains unknown. Clinicians, including hospitalists, pulmonologists, intensivists, medical examiners, pathologists, and the like, should report possible cases as the medical community continues to assess the health risks of e-cigarette use.
Collapse
Affiliation(s)
- Michael Oriakhi
- Internal Medicine, Medical Center Navicent Health, Macon, USA
| |
Collapse
|
6
|
Nyman AL, Huang J, Weaver SR, Eriksen MP. Perceived Comparative Harm of Cigarettes and Electronic Nicotine Delivery Systems. JAMA Netw Open 2019; 2:e1915680. [PMID: 31747029 PMCID: PMC6902805 DOI: 10.1001/jamanetworkopen.2019.15680] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This survey study examines the changing attitudes regarding the perceived harm of electronic nicotine delivery systems (ENDS) among smokers, nonsmokers, and ENDS users from 2017 to 2018.
Collapse
Affiliation(s)
- Amy L. Nyman
- Georgia State University School of Public Health, Atlanta
| | - Jidong Huang
- Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta
| | - Scott R. Weaver
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta
| | - Michael P. Eriksen
- Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta
| |
Collapse
|