The impact of flavors, health risks, secondhand smoke and prices on young adults’ cigarette and e-cigarette choices: a discrete choice experiment

In response to both the growth in the use of e-cigarettes and the formation of smoking habits in young adulthood, regulators are considering a range of tobacco control policies. In the US, policymakers at different tiers of government have the authority to regulate tobacco products and attributes, including flavors, components related to the products’ health harms and prices. However, optimal policies remain unclear, in part because evidence on young adults’ responses to, and trade-offs between, these attributes is limited.

To address this lack of information, we conduct an online discrete choice experiment (DCE) in which young adults (ages 18-22) choose among combustible cigarettes, two types of e-cigarettes (disposable or refillable), and “none of these.” Each cigarette-type is characterized by four attributes: (1) available flavors, (2) short-term health risks, (3) risks to others (secondhand smoke), and (4) price. Our sample is structured to be representative of young adults in the US who have ever tried either combustible or electronic cigarettes, with a final sample size of 2,003 respondents.

DCE responses are used to estimate preferences for cigarette types and the aforementioned attributes. We find that young adults fall into two broad categories. One group, which we term ‘smokers’ has a preference for combustible cigarettes (46% of the sample); and another, which we term ‘vaper-triers’ has a preference for e-cigarettes (54% of the sample). Smokers value lower prices and lower health harms; vaper-triers value lower prices, lower health harms and also fruit/candy flavors. Since combustible cigarettes are thought to be much more harmful than e-cigarettes, we argue that the smoker group should be the priority for regulators. Thus, taxes and health harm-based regulations (e.g. education campaigns of reduced risks) will discourage the more vulnerable young adults. Flavor bans will discourage the use of e-cigarettes.