title: The effect of potential electronic nicotine delivery system regulations on nicotine product selection.
abstract: OBJECTIVE
  To estimate the effect of potential regulations of electronic nicotine delivery systems (ENDS) among adult smokers, including increasing taxes, reducing flavor availability and adding warning labels communicating various levels of risk.
  
  
  METHODS
  We performed a discrete choice experiment (DCE) among a national sample of 1200 adult smokers. We examined heterogeneity in policy responses by age, cigarette quitting interest and current ENDS use. Our experiment overlapped January 2015 by design, providing exogenous variation in cigarette quitting interest from New Year resolutions.
  
  
  METHODS
  KnowledgePanel, an online panel of recruited respondents.
  
  
  METHODS
  A total of 1200 adult smokers from the United States.
  
  
  METHODS
  Hypothetical purchase choice of cigarettes, nicotine replacement therapy and a disposable ENDS.
  
  
  RESULTS
  Increasing ENDS prices from $3 to $6 was associated with a 13.6 percentage point reduction in ENDS selection (P < 0.001). Restricting flavor availability in ENDS to tobacco and menthol was associated with a 2.1 percentage point reduction in ENDS selection (P < 0.001). The proposed Food and Drug Administration (FDA) warning label was associated with a 1.1 percentage point reduction in ENDS selection (P < 0.05) and the MarkTen warning label with a 5.1 percentage point reduction (P < 0.001). We estimated an ENDS price elasticity of -1.8 (P < 0.001) among adult smokers. Statistically significant interaction terms (P < 0.001) imply that price responsiveness was higher among adult smokers 18-24 years of age, smokers who have vaped over the last month and smokers with above the median quitting interest. Young adult smokers were 3.7 percentage points more likely to choose ENDS when multiple flavors were available than older adults (P < 0.001). Young adult smokers and those with above the median cigarette quitting interest were also more likely to reduce cigarette selection and increase ENDS selection in January 2015 (P < 0.001), potentially in response to New Year's resolutions to quit smoking.
  
  
  CONCLUSIONS
  Increased taxes, a proposed US Food and Drug Administration warning label for electronic nicotine delivery systems and a more severe warning label may discourage adult smokers from switching to electronic nicotine delivery systems. Reducing the availability of flavors may reduce ENDS use by young adult smokers.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Pesko
authors.affiliation: Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Kenkel
authors.affiliation: Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA.
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA.
authors.forename: Jenna M
authors.initials: JM
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D004348:Drug Labeling / Q000331:legislation & jurisprudence; D066300:Electronic Nicotine Delivery Systems / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D005260:Female; D005421:Flavoring Agents; D006801:Humans; D008297:Male; D009538:Nicotine / Q000008:administration & dosage* / Q000191:economics; D062789:Tobacco Products / Q000191:economics / Q000706:statistics & numerical data*; D061485:Tobacco Use Cessation Devices / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
chemical_list: D005421:Flavoring Agents; D009538:Nicotine
keywords: Electronic nicotine delivery systems; tobacco regulation; tobacco use