E-cigarette, heated tobacco, and cigarette preferences among Canadian e-cigarette users and nonusers: A discrete choice experiment

Objective The rapid increase in the use of e-cigarettes may facilitate the cessation of tobacco use, but may also introduce a new pathway to becoming addicted to nicotine. Our objective was to examine how e-cigarette users and young nonusers respond to product characteristics. Methods We conducted a discrete choice experiment that included choices over three products (vape pods, heated tobacco sticks, cigarettes) with four attributes: on-product health warnings, plain packaging for vape pods, nicotine concentration allowable in vape pods, and price, among residents of Alberta, Ontario, and Québec. Conditional logit regressions were used to estimate the relative effects that differing attribute levels had on respondents choosing a product they would most likely buy (or try if nonusers) and the product they believed would pose the least risk to their health. Results Relative to the weakest policies (i.e., no on-product warnings, branding on vape pod packaging, no restrictions on nicotine concentration, and lower prices), respondents preferred options without on-product warnings, lower prices, and lower nicotine concentration in vapes. On-product warnings were particularly salient and appeared to work synergistically. Among nonusers and users, a warning on all three products increased the predicted probability (Pr) of choosing ‘none’ from Pr 0.50 (95% CI 0.47, 0.53) to Pr 0.65 (95% CI 0.63, 0.68) and from Pr 0.10 (95% CI 0.09, 0.12) to Pr 0.18 (95% CI 0.16, 0.21), respectively. Conclusion On-product warnings (separate from traditional warnings on the package) may reduce experimentation and use of e-cigarettes and cigarettes, while higher prices may reduce use.