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Snyder K, Liu ST, Donaldson EA, Wang T, Gentzke A. Exposure Among Middle and High School Students to Warning Labels on E-Cigarette Packages Before and After an FDA Requirement, 2018-2019. Prev Chronic Dis 2024; 21:E16. [PMID: 38483809 PMCID: PMC10944637 DOI: 10.5888/pcd21.220411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Introduction Beginning August 10, 2018, a US Food and Drug Administration (FDA) rule required all e-cigarette packages to have a health warning. We examined exposure among middle and high school students to e-cigarette warnings before and after the compliance date of the FDA's deeming rule, a rule allowing the FDA to regulate e-cigarettes, cigars, and other products. Methods We analyzed data from middle and high school students participating in the 2018 and 2019 National Youth Tobacco Survey. We generated weighted prevalence estimates for any exposure ("rarely," "sometimes," "most of the time," or "always") and high exposure ("most of the time" or "always") to warnings. We used independent 2-sided t tests to examine differences in exposure between 2018 and 2019 and χ2 tests to examine differences in any exposure and high exposure by demographic characteristics and tobacco use behaviors in 2019. Analyses excluded respondents who reported they had not seen an e-cigarette package. Results In 2019, 68.0% (vs 67.7% in 2018) of students reported any past 30-day exposure to e-cigarette warning labels and 35.0% (vs 28.7% in 2018) reported high exposure; we observed differences in the proportion of students reporting any and high exposure to warning labels across demographic characteristics and tobacco use behaviors. From 2018 to 2019, report of any and high exposure to e-cigarette warning labels increased among students who currently used any tobacco product and e-cigarettes. We observed increases in high exposure to e-cigarette warning labels overall, and among male students, female students, non-Hispanic White students, and middle and high school students. Conclusion After implementation of the health warnings per the FDA's deeming rule, the percentage of current tobacco users and e-cigarette users among middle and high school students who reported any and high exposure to e-cigarette warning labels increased. Continued monitoring of reactions can inform if warnings are achieving their regulatory goal.
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Affiliation(s)
- Kimberly Snyder
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
- Office of Science, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993
| | - Sherry T Liu
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Elisabeth A Donaldson
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Teresa Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Shang C, Weaver SR, White JS, Huang J, Nonnemaker J, Cheng KW, Chaloupka FJ. E-cigarette Product Preferences among Adult Smokers: A Discrete Choice Experiment. TOB REGUL SCI 2020; 6:66-80. [PMID: 32190716 PMCID: PMC7079730 DOI: 10.18001/trs.6.1.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In this study, we used a discrete choice experiment (DCE) conducted August-October 2017 to examine electronic nicotine delivery systems (ENDS) product preferences in a national sample of adult smokers (N = 1154) who were also using ENDS or had not ruled out future use. METHODS The DCE evaluated 5 ENDS attributes: relative harm; effectiveness for helping smokers quit; nicotine strength; flavor; and price. We asked participants to choose among their own cigarettes, 2 ENDS products whose attributes varied across tasks, or none. We analyzed ENDS preferences using multinomial, nested, and mixed logit regressions. RESULTS Smokers preferred ENDS that are less harmful than cigarettes, are effective in helping smokers quit, are lower priced, and are not menthol-flavored. The marginal willingness to pay for an ENDS product was $8.40 when less harmful than cigarettes, $4.13 when of unknown effectiveness in helping quitting ($13.90 when effective), and $3.37 when ENDS are not menthol-flavored. Furthermore, the overall flavor preference is driven by tobacco smokers, not by menthol cigarette smokers who do prefer menthol-flavored ENDS. CONCLUSIONS Policies that affect perceptions of ENDS effectiveness in promoting cessation and their relative harm may alter smokers' ENDS preferences. Regulating flavors and price also may influence adult smokers' ENDS preference.
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Affiliation(s)
- Ce Shang
- Ce Shang, Assistant Professor, Department of Pediatrics, Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Scott R. Weaver, Research Associate Professor, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA. Justin S. White, Assistant Professor, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA. Jidong Huang, Associate Professor, Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA. James Nonnemaker, Senior Research Scientist, RTI International Research Triangle Park, Durham, NC. Kai-Wen Cheng, Assistant Professor, Department of Health Administration, Governors State University, University Park, IL. Frank J. Chaloupka, Professor, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Scott R Weaver
- Ce Shang, Assistant Professor, Department of Pediatrics, Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Scott R. Weaver, Research Associate Professor, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA. Justin S. White, Assistant Professor, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA. Jidong Huang, Associate Professor, Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA. James Nonnemaker, Senior Research Scientist, RTI International Research Triangle Park, Durham, NC. Kai-Wen Cheng, Assistant Professor, Department of Health Administration, Governors State University, University Park, IL. Frank J. Chaloupka, Professor, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Justin S White
- Ce Shang, Assistant Professor, Department of Pediatrics, Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Scott R. Weaver, Research Associate Professor, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA. Justin S. White, Assistant Professor, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA. Jidong Huang, Associate Professor, Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA. James Nonnemaker, Senior Research Scientist, RTI International Research Triangle Park, Durham, NC. Kai-Wen Cheng, Assistant Professor, Department of Health Administration, Governors State University, University Park, IL. Frank J. Chaloupka, Professor, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Jidong Huang
- Ce Shang, Assistant Professor, Department of Pediatrics, Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Scott R. Weaver, Research Associate Professor, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA. Justin S. White, Assistant Professor, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA. Jidong Huang, Associate Professor, Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA. James Nonnemaker, Senior Research Scientist, RTI International Research Triangle Park, Durham, NC. Kai-Wen Cheng, Assistant Professor, Department of Health Administration, Governors State University, University Park, IL. Frank J. Chaloupka, Professor, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - James Nonnemaker
- Ce Shang, Assistant Professor, Department of Pediatrics, Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Scott R. Weaver, Research Associate Professor, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA. Justin S. White, Assistant Professor, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA. Jidong Huang, Associate Professor, Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA. James Nonnemaker, Senior Research Scientist, RTI International Research Triangle Park, Durham, NC. Kai-Wen Cheng, Assistant Professor, Department of Health Administration, Governors State University, University Park, IL. Frank J. Chaloupka, Professor, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Kai-Wen Cheng
- Ce Shang, Assistant Professor, Department of Pediatrics, Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Scott R. Weaver, Research Associate Professor, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA. Justin S. White, Assistant Professor, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA. Jidong Huang, Associate Professor, Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA. James Nonnemaker, Senior Research Scientist, RTI International Research Triangle Park, Durham, NC. Kai-Wen Cheng, Assistant Professor, Department of Health Administration, Governors State University, University Park, IL. Frank J. Chaloupka, Professor, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Frank J Chaloupka
- Ce Shang, Assistant Professor, Department of Pediatrics, Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Scott R. Weaver, Research Associate Professor, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA. Justin S. White, Assistant Professor, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA. Jidong Huang, Associate Professor, Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA. James Nonnemaker, Senior Research Scientist, RTI International Research Triangle Park, Durham, NC. Kai-Wen Cheng, Assistant Professor, Department of Health Administration, Governors State University, University Park, IL. Frank J. Chaloupka, Professor, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
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