Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 154 No. 3 (2024)

A discrete choice experiment on price and flavour effects on the appeal of nicotine products: a pilot study among young adults in Switzerland

DOI
https://doi.org/10.57187/s.3733
Cite this as:
Swiss Med Wkly. 2024;154:3733
Published
15.03.2023

Summary

AIMS: To explore the effects of prices and flavour availability on the appeal of different tobacco and nicotine products, including conventional cigarettes, Electronic Nicotine Delivery Systems (ENDS) and Heated Tobacco Systems (HTS) among an adult population in Switzerland.

METHODS: We performed a Discrete Choice Experiment among a group of Swiss aged ≥18 years via the online recruiting platform Prolific in a convenience sample. Our sample included both non-smokers and smokers. We used a within-subject, alternative-specific block design in a series of choice sets including different smoking products. We fixed the attributes of nicotine content (high or medium) and harmfulness (in years of life lost) for each product. Attributes of interest included price (ranging from CHF 5 to 25 in increments of 5) and flavour (fruity/menthol vs none/tobacco flavour). We performed a conditional logistic regression on the attributes’ influence on the appeal of cigarettes, ENDS and HTS.

RESULTS: A total of 108 out of 153 participants (n = 25 smokers and n = 83 non-smokers, completion rate = 71%) successfully completed our pilot survey experiment. We found that, in general, increasing the price of combustible cigarettes, ENDS and HTS by one standard deviation (around CHF 7) reduced their appeal by approximately 66% (relative risk [RR]: 0.34; 95% CI: 0.28–0.42). Unflavoured alternative nicotine products were found to be less appealing than flavoured products, especially for non-smokers, with a 86% decrease in appeal (RR: 0.14; 95% CI: 0.13–0.16). For non-smokers, an increase in price by one standard deviation was associated with a decrease in the appeal of any product by approximately 19% (RR: 0.81; 95% CI: 0.72–0.92). For smokers, the effect sizes were smaller, but overall, the appeal of all products decreased with increasing prices and reduced flavours.

CONCLUSIONS: Our Discrete Choice Experiment suggests that, for the Swiss context, limiting the availability of flavours for alternative smoking products has the potential to reduce their appeal to non-smokers by 86% and that a small but significant increase in prices to CHF 15 for cigarettes, ENDS and HTS could lead to a major (around 66%) decrease in their appeal.

References

  1. Bundesamt für Gesundheit. Antwort auf die Frage der Kommission vom 19 . Februar 2019 Bericht 3: Alternativprodukte : Chancen und Risiken für die öffentliche Gesundheit. 2019.
  2. Auer R, Concha-Lozano N, Jacot-Sadowski I, Cornuz J, Berthet A. Heat-not-burn tobacco cigarettes: smoke by any other name. JAMA Intern Med. 2017 Jul;177(7):1050–2. 10.1001/jamainternmed.2017.1419 DOI: https://doi.org/10.1001/jamainternmed.2017.1419
  3. 6 important things to know about IQOS [Internet]. [cited 2021 Nov 6]. Available from: https://truthinitiative.org/research-resources/emerging-tobacco-products/6-important-things-know-about-iqos-new-heated
  4. Walley SC, Wilson KM, Winickoff JP, Groner J. A Public Health Crisis: Electronic Cigarettes, Vape, and JUUL [Internet]. Pediatrics. 2019 Jun;143(6):e20182741. Available from: https://pediatrics.aappublications.org/content/143/6/e20182741 10.1542/peds.2018-2741 DOI: https://doi.org/10.1542/peds.2018-2741
  5. Czoli CD, Goniewicz M, Islam T, Kotnowski K, Hammond D. Consumer preferences for electronic cigarettes: results from a discrete choice experiment. Tob Control. 2016 Apr;25(e1 E1):e30–6. 10.1136/tobaccocontrol-2015-052422 DOI: https://doi.org/10.1136/tobaccocontrol-2015-052422
  6. Eidgenössische Kommission für Tabakprävention. Elektronische Zigaretten (E-Zigaretten) Position der Eidgenössischen Kommission für Tabakprävention [Internet]. 2019. Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/npp/tabak/stellungnahmen-medienmitteilungen-ektp/ektp-stellungnahme-e-zigaretten-2019.pdf.download.pdf/SN_EKTP_E-Zigaretten.pdf
  7. Delgrande Jordan M, Balsiger N, Schmidhauser V. La consommation de substances psychoactives des 11 à 15 ans en Suisse – Situation en 2022 et évolution dans le temps – Résultats de l’étude Health Behaviour in School-aged Children (HBSC). Rapport de recherche No 149 [Internet]. Lausanne; 2023 Mar. Available from: https://www.hbsc.ch/pdf/hbsc_bibliographie_382.pdf DOI: https://doi.org/10.58758/rech149
  8. Zahlen & Fakten. Tabak [Internet]. [cited 2021 Jan 26]. Available from: https://www.bag.admin.ch/bag/de/home/zahlen-und-statistiken/zahlen-fakten-zu-sucht/zahlen-fakten-zu-tabak.html
  9. Delgrande JM, Schneider E, Eichenberger Y, Kretschmann A. La consommation de substances psychoactives des 11 à 15 ans en Suisse - Situation en 2018 et évolutions depuis 1986 - Résultats de l’étude Health Behaviour in School-aged Children. HBSC; 2019. 190 pp.[Internet], Available from https://www.suchtschweiz.ch/fileadmin/user_upload/DocUpload/HBSC-2018-rr-100.pdf
  10. Kuendig H, Notari L, Gmel G. Cigarette électronique et autres produits du tabac de nouvelle génération en Suisse en 2016 - Analyse des données du Monitorage suisse des addictions [Internet]. 2017. Available from: http://www.suchtmonitoring.ch/docs/library/kuendig_o6c0u4xw5o5v.pdf
  11. Wang TW, Neff LJ, Park-Lee E, Ren C, Cullen KA, King BA. E-cigarette Use Among Middle and High School Students - United States, 2020 [Internet]. MMWR Morb Mortal Wkly Rep. 2020 Sep;69(37):1310–2. Available from: http://www.cdc.gov/mmwr/volumes/69/wr/mm6937e1.htm?s_cid=mm6937e1_w 10.15585/mmwr.mm6937e1 DOI: https://doi.org/10.15585/mmwr.mm6937e1
  12. Ruggia L. Heated Tobacco Products: Deep Dive Switzerland: A Policy Brief [Internet]. Bern; 2020. Available from: https://portal.at-schweiz.ch/images/pdf/wissenschfatliche_factsheets/htp_deep_dive_26_08_2020.pdf
  13. Donauer D, Weber C, Mühlebach S. Die E-Zigarette im schweizerischen Recht. Die Zulässigkeit des Handels von E-Zigaretten in der Schweiz sowie damit zusammenhängende rechtliche Fragestellungen und Entwicklungen. Jusletter; 2018.
  14. Conversion rates - Purchasing power parities (PPP) - OECD Data [Internet]. [cited 2021 May 18]. Available from: https://data.oecd.org/conversion/purchasing-power-parities-ppp.htm
  15. Bild des Monats. GfK Kaufkraft Europa 2019 [Internet]. [cited 2021 May 18]. Available from: https://www.gfk.com/de/insights/bild-des-monats-gfk-kaufkraft-europa-2019
  16. Jakob J, Cornuz J, Diethelm P. Prevalence of tobacco smoking in Switzerland: do reported numbers underestimate reality? Swiss Med Wkly. 2017 May;147(May):w14437. DOI: https://doi.org/10.4414/smw.2017.14437
  17. Jakob J, Joss S, Meier AN, Tal K, Schoeni A, Marti J, et al. The price of nicotine dependence: A comparison of the cost of nicotine across products in Switzerland, Germany, USA, Sweden, France and the UK, in 2019. Tob Prev Cessat. 2022 Nov;8(November):42. 10.18332/tpc/156052 DOI: https://doi.org/10.18332/tpc/156052
  18. WHO. WHO Technical Manual on Tobacco Tax Administration. Geneva: WHO; 2010.
  19. van Hasselt M, Kruger J, Han B, Caraballo RS, Penne MA, Loomis B, et al. The relation between tobacco taxes and youth and young adult smoking: what happened following the 2009 U.S. federal tax increase on cigarettes? Addict Behav. 2015 Jun;45:104–9. 10.1016/j.addbeh.2015.01.023 DOI: https://doi.org/10.1016/j.addbeh.2015.01.023
  20. Guindon GE, Paraje GR, Chaloupka FJ. The impact of prices and taxes on the use of tobacco products in Latin America and the Caribbean. Am J Public Health. 2018;108 S6:S492–502. 10.2105/AJPH.2014.302396r DOI: https://doi.org/10.2105/AJPH.2014.302396r
  21. Design and Administration of Taxes on Tobacco Products. In: The Economics of Tobacco and Tobacco Control [Internet]. 2016. p. 163–94. Available from: https://cancercontrol.cancer.gov/brp/tcrb/monographs/21/docs/m21_5.pdf
  22. Chaloupka FJ, Sweanor D, Warner KE. Differential Taxes for Differential Risks—Toward Reduced Harm from Nicotine-Yielding Products. N Engl J Med. 2015 Aug;373(7):594–7. 10.1056/NEJMp1505710 DOI: https://doi.org/10.1056/NEJMp1505710
  23. DeCicca P, Kenkel D, Lovenheim M. The Economics of Tobacco Regulation: A Comprehensive Review [Internet]. Ssrn. Cambridge, MA; 2020 Apr. Available from: http://www.nber.org/papers/w26923.pdf 10.3386/w26923 DOI: https://doi.org/10.3386/w26923
  24. Merz L. E-Cigarette Taxation in the United States: A Comparison and Health Policy Review Study [Internet]. University of Zurich; 2020. Available from: https://www.zora.uzh.ch/id/eprint/200816/
  25. ESTxENDS | Studie zur Rauchentwöhnung mit Hilfe von nikotinhaltigen E-Zigaretten [Internet]. [cited 2021 Aug 5]. Available from: https://www.estxends.ch/
  26. Jenssen BP, Walley SC, Groner JA, Rahmandar M, Boykan R, Mih B, et al.; SECTION ON TOBACCO CONTROL. E-cigarettes and similar devices. Pediatrics. 2019 Feb;143(2):e20183652. 10.1542/peds.2018-3652 DOI: https://doi.org/10.1542/peds.2018-3652
  27. Stoklosa M, Drope J, Chaloupka FJ. Prices and E-Cigarette Demand: Evidence From the European Union. Nicotine Tob Res. 2016 Oct;18(10):1973–80. 10.1093/ntr/ntw109 DOI: https://doi.org/10.1093/ntr/ntw109
  28. Saffer H, Grossman M, Dench D, Dave D. E-Cigarettes and Adult Smoking: Evidence from Minnesota. NBER Working Paper No. 26589. 2019. DOI: https://doi.org/10.3386/w26589
  29. Pesko M, Courtemanche C, Maclean JC. The Effects of Traditional Cigarette and E-Cigarette Taxes on Adult Tobacco Product Use. NBER Working Paper Series. Cambridge; 2019. DOI: https://doi.org/10.3386/w26017
  30. Regmi K, Kaphle D, Timilsina S, Tuha NA. Application of Discrete-Choice Experiment Methods in Tobacco Control: A Systematic Review. PharmacoEconom Open. 2018 Mar;2(1):5–17. 10.1007/s41669-017-0025-4 DOI: https://doi.org/10.1007/s41669-017-0025-4
  31. Kjaer T. A review of the discrete choice experiment - with emphasis on its application in health care. Heal Econ Pap. 2005;(1):1–139.
  32. Monzón J, Islam F, Mus S, Thrasher JF, Barnoya J. Effects of tobacco product type and characteristics on appeal and perceived harm: Results from a discrete choice experiment among Guatemalan adolescents. Prev Med. Baltim; 2021. p. 148. DOI: https://doi.org/10.1016/j.ypmed.2021.106590
  33. Merz L, Puhan MA. Taxation options for nicotine and tobacco products in Switzerland - a review of tax policies. Swiss Med Wkly. 2021 Dec;151(51–52):w30083. 10.4414/SMW.2021.w30083 DOI: https://doi.org/10.4414/SMW.2021.w30083
  34. Marti J, Buckell J, Maclean JC, Sindelar J. To “vape” or smoke? Experimental evidence on adult smokers. Econ Inq. 2019 Jan;57(1):705–25. 10.1111/ecin.12693 DOI: https://doi.org/10.1111/ecin.12693
  35. Soziale und wirtschaftliche Lage der Studierenden | Bundesamt für Statistik [Internet]. [cited 2023 May 4]. Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/bildung-wissenschaft/personen-ausbildung/tertiaerstufe-hochschulen/soziale-wirtschaftliche-lage-studierenden.html
  36. Johnson FR, Yang JC, Reed SD. The Internal Validity of Discrete Choice Experiment Data: A Testing Tool for Quantitative Assessments. Value Heal [Internet]. 2019 Feb;22(2):157–60. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1098301518332339 10.1016/j.jval.2018.07.876 DOI: https://doi.org/10.1016/j.jval.2018.07.876
  37. Cantrell J, Huang J, Greenberg MS, Xiao H, Hair EC, Vallone D. Impact of e-cigarette and cigarette prices on youth and young adult e-cigarette and cigarette behaviour: evidence from a national longitudinal cohort. Tob Control. 2019;(January):1–7. 10.1136/tobaccocontrol-2018-054764 DOI: https://doi.org/10.1136/tobaccocontrol-2018-054764
  38. Pesko MF, Kenkel DS, Wang H, Hughes JM. The effect of potential electronic nicotine delivery system regulations on nicotine product selection. Addiction. 2016 Apr;111(4):734–44. 10.1111/add.13257 DOI: https://doi.org/10.1111/add.13257
  39. STATE System E-Cigarette Fact Sheet [Internet]. [cited 2021 Aug 6]. Available from: https://www.cdc.gov/statesystem/factsheets/ecigarette/ECigarette.html
  40. Buckell J, Marti J, Sindelar JL. Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment [Internet]. Tob Control. 2019 Mar;28(2):168–75. Available from: https://tobaccocontrol.bmj.com/lookup/doi/10.1136/tobaccocontrol-2017-054165 10.1136/tobaccocontrol-2017-054165 DOI: https://doi.org/10.1136/tobaccocontrol-2017-054165
  41. de Corte K, Cairns J, Grieve R. Stated versus revealed preferences: an approach to reduce bias. Health Econ. 2021 May;30(5):1095–123. 10.1002/hec.4246 DOI: https://doi.org/10.1002/hec.4246

Most read articles by the same author(s)