Background Policymakers wishing to encourage smokers unable to quit to switch to using electronic nicotine delivery systems (ENDS) also need to consider how to deter ENDS use among non-smokers. We examined whether reduced-risk messages could increase ENDS’ appeal among smokers and if increased-risk messages could decrease appeal among susceptible non-smokers, occasional and former smokers.
Methodology An online discrete choice experiment tested three attributes: information message, nicotine content (0 mg or 3 mg) and flavour (tobacco, menthol or fruit). The sample comprised 352 current smokers, 118 occasional and former smokers, and 216 ENDS-susceptible never smokers. Smokers viewed reduced-risk messages that encouraged switching to ENDS, while other groups viewed increased-risk messages that discouraged ENDS use. All groups saw a typical addiction warning. We analysed the data by estimating multinomial logit regression and adjusted latent class analysis models.
Results Relative to no message, reduced risk-messages increased the appeal of ENDS uptake among one class of smokers (33.5%) but decreased appeal among other smokers. However, among all smokers, reduced-risk messages increased preference more than a dissuasive addiction warning. By contrast, among occasional or former smokers, and susceptible non-smokers, all information messages discouraging ENDS use, including an addiction warning, decreased preference relative to no message.
Conclusions On-pack relative-risk messages about ENDS could make transition more attractive to smokers while increased-risk messages could deter ENDS uptake among susceptible non-smokers, occasional and former smokers. Communicating diverse messages via discrete channels could recognise heterogeneity among and between smokers and non-smokers.
- public policy
- packaging and labelling
- electronic nicotine delivery devices
Statistics from Altmetric.com
Contributors JH conceptualised the project and obtained funding. PG and JH designed the research instrument; PG and JL designed the choice experiment; PL and LP provided feedback on the study instrument. PG managed the data collection and, with CE, analysed and interpreted the data; CE estimated the multi-nomial logit regression model and Latent Class models. PG and JH led the MS development and revisions; CE provided feedback on early versions of the MS; all other authors reviewed subsequent versions and have approved the final MS version. Authors are listed in descending order of contribution. JH and PG are guarantors of the MS.
Funding This project was funded by the Health Research Council of New Zealand (Grant 16/149).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The University of Otago Human Ethics Committee reviewed and approved the study (approval 16/132), and we undertook formal consultation with the Ngāi Tahu Research Consultative Committee, which represents the interests of indigenous Māori peoples.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.