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Costs of vaping: Evidence from ITC Four Country Smoking and Vaping Survey

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Abstract

Study objectives To compare the prices paid for nicotine vaping products (NVPs) and supplies among current NVP users to prices paid for cigarettes among current smokers. Data The 2016 International Tobacco Control Four Country Vaping and Smoking Survey (4CV1). Key measures included: (1) self-reported prices paid for reusable NVPs (eg, rechargeable devices with cartridges and tank system devices with e-liquids) in the 3-month period prior to the survey among current NVP users, (2) prices paid for disposable NVPs, cartridges and e-liquids purchased in the last 30 days among current NVP users and (3) self-reported prices paid for cigarettes among current smokers. Results Disposable NVP price was higher than the price of a comparable unit for combustible cigarettes in England (EN), USA and Canada (CA). Prefilled cartridge price was higher than the price of a comparable unit of cigarettes in USA and CA, but lower in EN and Australia. E-liquid price was consistently lower than the price of a comparable unit of cigarettes across four countries. For start-up costs, price of a rechargeable device is approximately 3–5 times higher than a pack of cigarettes in four countries. Conclusion NVP prices were generally higher than prices of combustible cigarettes, especially the high upfront NVP devices. The high upfront costs of purchasing a reusable NVP may discourage some smokers from switching to vaping. However, the average lower costs of cartridges and e-liquids relative to a package of cigarettes make switching to a NVP an attractive alternative to smoking in the long term so long as smokers switch completely to vaping.
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ChengK- W, etal. Tob Control 2020;0:1–4. doi:10.1136/tobaccocontrol-2019-055344
Costs of vaping: evidence from ITC Four Country
Smoking and VapingSurvey
Kai- Wen Cheng ,1,2 Ce Shang,3 Hye Myung Lee,2 Frank J Chaloupka,2
Geoffrey T Fong ,4,5 Ron Borland ,6,7 Bryan W Heckman ,8,9
Sara C Hitchman ,10 Richard J O’Connor,11 David T Levy ,12
K. Michael Cummings 8,9
Original research
To cite: ChengK- W,
ShangC, LeeHM, etal.
Tob Control Epub ahead of
print: [please include Day
Month Year]. doi:10.1136/
tobaccocontrol-2019-055344
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please visit the journal online
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end of article.
Correspondence to
Dr Kai- Wen Cheng, Department
of Health Administration,
Governors State University,
University Park, IL 60466, USA;
kcheng@ govst. edu
Received 21 August 2019
Revised 12 November 2019
Accepted 19 November 2019
© Author(s) (or their
employer(s)) 2020. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published
by BMJ.
ABSTRACT
Study objectives To compare the prices paid for
nicotine vaping products (NVPs) and supplies among
current NVP users to prices paid for cigarettes among
current smokers.
Data The 2016 International Tobacco Control Four
Country Vaping and Smoking Survey (4CV1). Key
measures included: (1) self- reported prices paid for
reusable NVPs (eg, rechargeable devices with cartridges
and tank system devices with e- liquids) in the 3- month
period prior to the survey among current NVP users, (2)
prices paid for disposable NVPs, cartridges and e- liquids
purchased in the last 30 days among current NVP users
and (3) self- reported prices paid for cigarettes among
current smokers.
Results Disposable NVP price was higher than the
price of a comparable unit for combustible cigarettes in
England (EN), USA and Canada (CA). Prefilled cartridge
price was higher than the price of a comparable unit of
cigarettes in USA and CA, but lower in EN and Australia.
E- liquid price was consistently lower than the price of
a comparable unit of cigarettes across four countries.
For start- up costs, price of a rechargeable device is
approximately 3–5 times higher than a pack of cigarettes
in four countries.
Conclusion NVP prices were generally higher
than prices of combustible cigarettes, especially the
high upfront NVP devices. The high upfront costs of
purchasing a reusable NVP may discourage some
smokers from switching to vaping. However, the average
lower costs of cartridges and e- liquids relative to a
package of cigarettes make switching to a NVP an
attractive alternative to smoking in the long term so long
as smokers switch completely to vaping.
INTRODUCTION
While cigarettes are the most frequently used nico-
tine product among adults around the world, use
of non- cigarette nicotine products and multiple
products is growing in popularity.1 Among the non-
cigarette nicotine products, nicotine vaping prod-
ucts (NVPs), a vaping device or vaporiser delivering
nicotine in vapour or aerosol form, have gained
substantial global market share. In 2017, North
America was the largest NVP product market in the
world, followed by Western Europe, led by the UK,
Eastern Europe, Asia Pacific and then the rest of
the world.2 In 2018, global sales of NVP reached
US$13 billion and are expected to continue their
rapid growth over the coming years.2 An estimated
35 million people were NVP users in 2016, a
number projected to grow to 55 million by 2021.2
Several factors may be driving the growing popu-
larity of NVPs. Among them, the relatively lower cost
of vaping compared with smoking is thought to be
a key factor. Recent evidence suggests that NVP use
and sales are price- sensitive, such that an increase of
NVP price is associated with a decrease in NVP sales
and use prevalence.3–7 In addition to being sensitive
to its own price, NVP sales and use are sensitive to the
prices of other nicotine products. A change in relative
prices among nicotine products, such as cigarettes,
cigars, NVPs (disposable, open system device, closed
system device) may lead users to switch to using the
alternatives with lower prices.3–5
The relative price of NVPs compared with ciga-
rettes is likely an important factor in driving growth
of NVPs. However, limited empirical work has
measured and described the prices of NVP products
compared with cigarettes in different markets. A
review of global data found that NVP users’ impres-
sions of cost were inconsistent such that some
thought NVPs saved money while others believed
that NVPs cost more money.8 Jackson et al9 used
England household survey and found the expen-
diture on nicotine products among NVP users is
approximately one third of the expenditure among
cigarette smokers.9
Liber et al (2017) used data from multiple coun-
tries and comparing prices of NVPs with respect to
combustible cigarettes. They found that global NVP
prices are generally much higher than those of ciga-
rettes, while e- liquids (mL) cost less, particularly in
high- income countries.
For the US study, most of the data on cigarette
and NVP prices comes from Nielsen Scanner
Track where studies show the trends in NVP prices
have decreased between 2012 and 2016 and the
price gaps for NVP devices and cigarettes has
narrowed.3 10 11
Liber et al (2017) used Euromonitor Interna-
tional data which provides only a selected sample
of NVP product prices, and it is uncertain whether
their prices for disposable NVPs and e- liquids can
be representative of all product prices in each
country.12 Nielsen Scanner Track data have the sales
information from participating retailers, which only
reflects about 1/3 or less of the NVP purchases.13
Our study extends previous studies reporting
on the price of NVPs by using the self- reported
prices of NVPs and cigarettes from NVP users
and smokers in the four countries (Australia (AU),
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Original research
Table 1 Average price of cigarettes and nicotine vaping products without outliers, 95% CI in brackets, dollar amount in local currency
Cigarette
(per stick)
Disposable
(per stick)
E- liquid Cartridge
E- liquid
(per ml)
Rechargeable
(per device)
Cartridge
(per mL)
Rechargeable
(per device)
Australia $0.91 (0.89 to 0.93) $9.90 (4.21 to 15.59) $0.47 (0.44 to 0.50) $85.61 (79.36 to 91.85) $2.23 (0.31 to 4.15) $57.59 (41.71 to 73.48)
Canada $0.49 (0.48 to 0.50) $11.84 (9.09 to 14.60) $0.85 (0.71 to 0.98) $58.20 (52.84 to 63.57) $3.84 (3.17 to 4.51) $38.16 (33.64 to 42.68)
England £0.41 (0.40 to 0.42) £8.93 (6.68 to 11.17) £0.34 (0.32 to 0.37) £25.10 (23.16 to 27.04) £1.67 (1.42 to 1.92) £16.86 (15.28 to 18.44)
USA $0.39 (0.37 to 0.41) $14.85 (11.06 to 18.63) $0.91 (0.75 to 1.04) $44.81 (39.73 to 49.60) $3.49 (2.94 to 4.03) $34.16 (29.62 to 38.69)
Canada (CA), England (EN) and the USA), which represents a
majority of global NVP sale. Using self- reported prices allows
us collect prices of NVPs obtained from different purchase loca-
tions (eg, retailers, vape shops and online). Our study aims to (1)
assess the unit comparable prices of NVPs, by standardising the
self- reported nicotine content/volume in different types of NVPs
and (2) assess the upfront cost of rechargeable NVP device.
METHODS
Data
Data were obtained from the international tobacco control (ITC)
Four Country Smoking and Vaping Survey Wave 1 (2016) (ITC
4CV1). Details about this survey can be found in Thompson et
al (2019).14
The ITC 4CV1 Survey provided information on self- reported
prices of reusable vaping devices (eg, rechargeable devices with
cartridges and tank system devices with e- liquids) among the ever
NVP users who purchased a vaping device in the past 3 months.
The survey also provided information on self- reported prices of
disposable NVPs, cartridges and e- liquids among the ever NVP
users who had purchased any disposable, cartridges and/or e- liquid
in the last 30 days. Current smokers who reported using factory-
made cigarettes provided their cigarette price information.
After removing outliers (±2 SD from the mean; n=152(2%)
for the removed price outliers and n=53 (4%) for the removed
NVP device price outliers), our final sample size is 9125 for ciga-
rette price, disposable price, e- liquid price, cartridge price and
1200 for rechargeable device with cartridges and tank system
device with e- liquids for AU, CA, EN and USA (online supple-
mentary tables A-1 and A-2).
Measures
Cigarette prices per stick
Current smokers who smoked and purchased combustible
and factory- made cigarettes were asked in which form they
purchased cigarettes: by the stick, pack, carton or bag. Based
on these purchase forms as well as the reported number of ciga-
rettes per pack, carton or bag, price per stick was calculated. A
small number of respondents (AU=4, CA=6, EN=14, USA=15)
reported that they purchased factory- made cigarette loose out of
packs. For those who purchased loose cigarettes, cigarette prices
were divided by the number of cigarettes purchased.
NVP prices
Current NVP users who purchased a reusable vaping device
(eg, replaceable prefilled cartridges and tank system filled with
liquids) in the last 3 months were asked to report the price for
the rechargeable device (rechargeables with cartridges and tank
systems with e- liquids).
NVP users who used prefilled cartridges most/last and
answered that they had made a purchase in the last 30 days were
asked to report price per cartridge. NVP users who answered
that they used tanks filled with liquid most/last were asked to
report price per bottle of e- liquid. Those who used disposables
most/last were asked to report the price per disposable NVP.
Capacity of e-liquid bottles and prefilled cartridges
For e- liquid bottles and prefilled cartridges, capacity/volume was
reported in millilitres (continuous variable) by users. Price per
bottle (or cartridge) was divided by the capacity/volume (ml) of
each bottle (or cartridge) in order to obtain the price per mL of
e- liquid (or cartridge).
Comparable price measures
We used the unit- standardised approaches suggested by Liber et
al (2017) to standardise NVP prices to a comparable unit, with
prices per pack of 20 cigarettes as an anchor. A single stick of
disposable NVP is a comparable unit for a pack of cigarettes, as
previous studies identified that a single stick of disposable NVP
produced a comparable number of puffs to a pack of combustible
cigarettes (150 puffs).15 16 For e- liquids, 3.55 mL is a comparable
unit for a pack of cigarettes, as its consumption time was equal
to the time in which typical pack- per- day smokers consume their
normal daily ratio of cigarettes.17 18 Using similar logic to calcu-
late a comparable unit for cartridges, the cartridge’s volume/
capacity is taken into account and a cartridge with 3.55 mL is
considered equivalent to a pack of 20 cigarettes.
Price ratio
Using this comparable unit standard, such that one pack of
cigarettes was considered to represent the equivalent level of
consumption as one disposable, 3.55 mL of e- liquid or 3.55 mL of
cartridge,19 three types of price ratios were generated with stan-
dardised cigarette price as the base: price ratios of disposables to
cigarettes, e- liquids to cigarettes and cartridges to cigarettes.
RESULTS
Prices for rechargeable devices
The average prices of e- liquid rechargeable device were AUD
85.61 (US$63.65), CAD 58.20 (US$43.92), £25.10 (US$33.87)
and US$44.81, in AU, CA, EN and the USA, respectively. The
average prices of rechargeable devices for cartridges were AUD
57.59 (US$42.81), CAD 38.16 (US$28.80), £ 16.86 (US$22.75)
and US$34.16, in AU, CA, EN and the USA, respectively. The
2016 currency exchange rate from OECD exchange rate data-
base was used to obtain device prices in US$ (table 1).
Price ratio: comparable prices for disposables, e-liquids and
cartridges
In AU, price ratios were 0.54 for disposables, 0.09 for e- liquid and
0.43 for cartridges. Interestingly, cigarettes were more expensive
than any NVP products in AU. In CA, the ratios were 1.21, 0.31
and 1.39, respectively. In EN, they were 1.09, 0.15 and 0.72,
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ChengK- W, etal. Tob Control 2020;0:1–4. doi:10.1136/tobaccocontrol-2019-055344
Original research
Table 2 Average price per comparable unit of cigarettes and nicotine vaping products, dollar amount in local currency
Cigarette (per pack) Disposable (per stick) E- liquid (for 3.55 mL) Cartridge (for 3.55 mL)
Australia $18.20 (17.80–18.60) $9.90 (4.21–15.59) $1.67 (1.56–1.78) $7.92 (1.10–14.73)
Canada $9.80 (9.60–10.00) $11.84 (9.09–14.60) $3.02 (2.52–3.48) $13.63 (11.25–16.01)
England £8.20 (8.00–8.40) £8.93 (6.68–11.17) £1.21 (1.14–1.31) £5.93 (5.04–6.82)
USA $7.80 (7.40–8.20) $14.85 (11.06–18.63) $3.23 (2.66–3.69) $12.39 (10.44–14.31)
Figure 1 Price ratios using cigarette price as the base: price ratios of
cigarettes to cigarettes, disposables to cigarettes, e- liquids to cigarettes
and cartridges to cigarettes in AU, CA, EN, and USA, respectively.
What this paper adds
What is already known on this subject
Use of non- cigarette nicotine products and multiple products
are growing in popularity around the world.
Nicotine vaping product (NVP) use and sales are sensitive to
its own price and also the prices of other nicotine products.
What important gaps in knowledge exist on this topic
Limited empirical work has measured and described the
prices of NVP products compared with cigarettes in different
markets.
What this paper adds
NVP prices were generally higher than prices of combustible
cigarettes, especially the high upfront NVP devices that may
discourage some smokers from switching to vaping.
However, the average lower costs of cartridges and e-
liquids relative to a package of cigarettes makes completely
switching to a NVP an attractive alternative to smoking in the
long term.
respectively. CA and EN showed similar relative prices, except
cartridges were more expensive than cigarettes in CA, while in
EN cartridges were cheaper than cigarettes. In the USA, price
ratios were 1.90, 0.41 and 1.59, respectively. Generally, USA had
the highest relative prices for disposable NVPs and cartridges
among the four countries, with disposable NVPs nearly twice as
expensive as conventional cigarettes (table 2 and figure 1).
DISCUSSION
This study provides the first evidence using self- reported prices
paid for NVP devices and supplies compared with cigarettes in
four countries. In general, we found price of disposable NVPs
to be higher than the price of a comparable unit for combustible
cigarettes in EN, USA and CA. Price of prefilled cartridges is
higher than the price of a comparable unit of combustible ciga-
rettes in USA and CA. By contrast, price of e- liquid is lower than
the price of a comparable unit of combustible in all four coun-
tries. In AU, price of all NVP types is consistently lower than the
price of a comparable unit of combustible, in part due to the very
high cigarette prices there.
For startup costs, the cost of purchasing a rechargeable NVP
with refilled cartridges or e- liquids is approximately 3–5 times
higher than purchasing a pack of cigarettes across all four
countries. For an average daily smoker who smokes around 15
cigarettes per day (CPD), it takes the equivalent of around 7
packs of 20 cigarettes to pay for the device, meaning the cost of
purchasing a rechargeable device could be recovered in approx-
imately 9–10 days.
In addition, our data indicate that while the startup price of
using rechargeable NVPs is relatively high, once the starter kit is
purchased, the additional cost for prefilled cartridges or bottles
of e- liquids may be a financially attractive alternative to factory-
made cigarettes, especially for smokers from AU and EN. The high
upfront costs of purchasing a reusable NVP may discourage some
smokers from switching to vaping. However, the average lower
costs of cartridges and e- liquids relative to a package of cigarettes
makes switching to a NVP an attractive alternative to smoking in
the long term so long as smokers switch completely to vaping.
The findings from this study underscores the importance of
policy makers considering how policies they implement might
impacting the relative price differential between NVPs and ciga-
rettes. For example, policies that restrict where NVPs are sold
could inadvertently increase the cost of NVPs relative to ciga-
rettes making NVPs less attractive as cigarette substitutes. Regu-
lators should consider tax systems for NVPs which imposes taxes
high enough to discourage initiation among young people, but
also keep the prices of NVPs low relative to the costs of ciga-
rettes which pose a greater risk to health.20
This study does have several limitations that needed to be
considered when interpreting the findings. First, our price
data came from the single year of 2016. Some of the price data
reported in this study when broken down by country and type
of product purchased are based on relatively small samples of
users which may yield unreliable price estimates. Second, this
study only examined factory- made cigarette prices and does not
take into account that many smokers report being able to obtain
cigarettes at cheap prices, such as through the use of (roll your
own) RYO.21 Thus, the price benefits from switching to NVPs for
RYO smokers are likely less than for smokers of factory- made
cigarettes. Third, NVP prices were standardised to a comparable
and equivalent unit for nicotine volume, but the standardised
nicotine unit does not imply that the delivered nicotine level is
equivalent or that the nicotine salts are relevant across products.
Future studies may benefit from complementing NVP prices
from multiple data sources and using larger- scale and longitu-
dinal data to explore the impact of relative prices on changes in
use patterns between cigarettes and NVPs.
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4ChengK- W, etal. Tob Control 2020;0:1–4. doi:10.1136/tobaccocontrol-2019-055344
Original research
CONCLUSION
NVP prices were generally higher than prices of combustible
cigarettes, especially the high upfront NVP devices, which
may create for current smokers a barrier to switching to NVPs.
However, the average lower costs of e- liquids relative to a
package of cigarettes makes switching to a NVP an attractive
alternative to smoking in the long term so long as smokers
switch completely to vaping. Our study is relevant for policy-
makers who are considering policies that could impact the cost
of NVPs such as excise taxes. We suggest that, while taxes should
be set high enough to discourage the initiation of any nicotine
products among nonusers, the tax rates applied on combustible
and NVPs should be differentiated, creating a price advantage
for NVPs relative to combustible cigarettes.
Author affiliations
1Department of Health Administration, Governors State University, University Park,
Illinois, USA
2Health Policy Center, Institute for Health Research and Policy, University of Illinois at
Chicago, Chicago, Illinois, USA
3Department of Pediatrics and Oklahoma Tobacco Research Center, University of
Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
4Department of Psychology and School of Public Health and Health Systems,
University of Waterloo, Waterloo, Ontario, Canada
5Ontario Institute for Cancer Research, Toronto, Ontario, Canada
6School of Psychological Sciences, University of Melbourne, Melbourne, Victoria,
Australia
7Cancer Council Victoria, Melbourne, Victoria, Australia
8Psychiatry and Behavioral Sciences, Medical University of South Carolina,
Charleston, South Carolina, USA
9Hollings Cancer Center, Medical University of South Carolina, Charleston, South
Carolina, United States
10Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience,
King’s College London, London, UK
11Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York,
USA
12Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown
University, Washington, District of Columbia, USA
Contributors K- WC wrote the original manuscript, conducted the empirical
analysis and revised the manuscript. CS provided valuable insight on the analysis.
HML managed the data and conducted statistical run. The other authors all took an
active role in developing the original ideas for the study, critiquing the analysis and
revising the manuscript.
Funding The ITC Four Country Smoking and Vaping Wave 2 Survey was
supported by grants from the US National Cancer Institute (P01 CA200512) and
the Canadian Institutes of Health Research (FDN-148477). The ITC Australia
Project was supported by National Health and Medical Research Council of
Australia (APP1106451). Additional support was provided to BWH by National
Institute on Drug Abuse (NIDA) of the National Institutes of Health (K23
DA041616) and to GTF from a Senior Investigator Award from the Ontario
Institute for Cancer Research.
Competing interests KMC has received grant funding from Pfizer, Inc. to study
the impact of a hospital- based tobacco cessation intervention. KMC also receives
funding as an expert witness in litigation filed against the tobacco industry. GTF
has served as an expert witness on behalf of governments in litigation involving the
tobacco industry.
Patient consent for publication Not required.
Ethics approval The survey protocols and all materials, including the survey
questionnaires, were cleared for ethics by Institutional Review Board, Medical
University of South Carolina; Research Ethics Office, King’s College London, UK;
Office of Research Ethics, University of Waterloo, Canada and Human Research
Ethics, Cancer Council Victoria, Australia.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. The data
are public. The authors will make these data available to all who request it.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non- commercial. See:http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.
ORCID iDs
Kai- WenCheng http:// orcid. org/ 0000- 0002- 5508- 2280
Geoffrey TFong http:// orcid. org/ 0000- 0001- 9098- 6472
RonBorland http:// orcid. org/ 0000- 0003- 0059- 178X
Bryan WHeckman http:// orcid. org/ 0000- 0003- 4148- 2467
Sara CHitchman http:// orcid. org/ 0000- 0001- 6155- 6916
David TLevy http:// orcid. org/ 0000- 0001- 5280- 3612
K. MichaelCummings http:// orcid. org/ 0000- 0002- 7103- 7017
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... Individuals unaware of e-cigarettes would be unlikely to consider them as more harmful than cigarettes, given the efforts to convey cigarettes as harmful. Additionally, the use of e-cigarettes involves a higher initial investment in the device itself 30 . However, over time, using e-cigarettes is cheaper than cigarettes 30 . ...
... Additionally, the use of e-cigarettes involves a higher initial investment in the device itself 30 . However, over time, using e-cigarettes is cheaper than cigarettes 30 . Thus, non-Hispanic Black adults may prioritize the immediate cost-saving benefits of cigarettes over the long-term savings of e-cigarettes. ...
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INTRODUCTION Patient–provider communication quality is instrumental for healthy outcomes in patients. The objective of this study is to examine the relationships between patient–provider communication quality and participant characteristics, perception of e-cigarette harmfulness, and smoking outcomes. METHODS A pooled cross-sectional design was used on secondary data obtained from the Health Information National Trends Survey (HINTS) 5 from Cycle 1 through Cycle 4, from 2017–2022. Our final sample contained 3511 observations. Our outcome variable was the perception of electronic cigarette smoking status. The independent variable was patient–provider communication quality (PPCQ), measured from a series of questions with responses on a 4-item Likert scale (always, usually, sometimes, never). Demographic variables such as marital status, health insurance status, occupation status, and health-related variables were used as participant characteristics. Ordinal logistic regression models were used to examine the above relationships. RESULTS Compared to males, females had lower odds of being in a higher category of perception of e-cigarette harmfulness compared to other categories of e-cigarette harmfulness (AOR=0.66; 95% CI: 0.57–0.76). Respondents who were non-Hispanic Black or Hispanic had lower odds of being in a higher category of perception of e-cigarettes compared to Whites (AOR=0.52; 95% CI: 0.49–0.78, and AOR=0.51; 95% CI: 0.41–0.65, respectively). Respondents who had higher education level compared to those with less than high school had lower odds (AOR=0.30; 95% CI: 0.17–0.51), and Hispanics compared to Whites had higher odds (AOR=1.59; 95% CI: 1.05–2.40), of being former smokers rather than current smokers. CONCLUSIONS Providers should invest in staff training and development to target the populations that need conversations regarding e-cigarette usage.
... Although most participants found the intervention to be helpful, some indicated that the cost of e-cigarettes and perceptions of not getting enough nicotine from e-cigarettes were barriers to continued use. The cost barrier may be addressed by providing information about the lower relative cost of e-cigarette pods versus CCs (Kai-Wen et al., 2021). However, it is noteworthy that the cost of purchasing start-up kits (e.g., e-cigarette device, charger, nicotine pods) and multi-packs of nicotine pods may deter people with few resources from using e-cigarettes. ...
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Background Smoking prevalence among U.S. adults experiencing homelessness is ≥70 %. Interventions are needed to address persisting tobacco disparities. Methods Adults who smoked combustible cigarettes (CC) daily (N=60) were recruited from an urban day shelter and randomly assigned to an e-cigarette switching intervention with or without financial incentives for carbon monoxide (CO)-verified CC abstinence (EC vs. EC+FI). All participants received an e-cigarette device and nicotine pods during the first 4 weeks post-switch; and those in the EC+FI group also received escalating weekly incentives for CC abstinence during the same period. Key follow-ups were conducted at 4- and 8-weeks post-switch. Results Participants were predominantly male (75 %), 50 % were racially/ethnically minoritized, with an average age of 48.8 years. Descriptive analyses indicated that CC smoking abstinence rates among EC and EC+FI were 3.3 % vs. 13.3 % at 4 weeks (8.3 % overall) and 10.0 % vs. 13.3 % at 8 weeks (11.7 % overall) in the intent-to-treat analyses (missing considered smoking). Among those who completed follow-ups (51.7 % and 45.0 % at 4- and 8-weeks), CC abstinence rates in EC and EC+FI were 6.3 % vs. 26.7 % at 4 weeks (16.1 % overall) and 21.4 % vs. 30.8 % at 8 weeks (25.9 % overall). EC+FI participants reported fewer days of smoking, more days of e-cigarette use, and greater reductions in CO at 4-week follow-up. Most participants reported a high likelihood of switching to e-cigarettes (67.7 %). Conclusion E-cigarette switching with financial incentives for CC cessation is a promising approach to tobacco harm reduction among adults accessing shelter services. Refinements are needed to improve engagement.
... This study found that patients were motivated to substitute cigarette smoking by use of ECs because of their cheaper cost. Patients' views on the cost of ECs relative to a combustible cigarette were consistent with a crosscountry survey 14 which showed that, although the initial upfront cost of a reusable EC device may be higher than the cost of cigarettes, the average costs of cartridges and e-liquids relative to a pack of cigarettes is lower. 14 The ENHANCE-D trial includes an economic evaluation which will explore this in more detail. ...
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Introduction Smoking is a major contributor to health inequalities in the UK. The ENHANCE-D trial is evaluating three smoking cessation interventions (nicotine replacement therapy [NRT], electronic cigarettes [ECs] or ‘very brief advice') delivered in NHS primary dental care. This qualitative study aimed to provide insight into the factors that could influence the adoption of the interventions in these settings. Methods Interviews were conducted at two timepoints. Purposive maximum variation sampling was used to recruit and interview a total of 24 dental patients, 12 dental professionals and three NHS dental commissioners. Thematic analysis was carried out using normalisation process theory as an analytical framework. Results Dental settings were perceived as an appropriate location to deliver smoking cessation interventions. Patients had several motivating and demotivating factors regarding use of NRTs or ECs; they often had negative preconceptions. Financial considerations were major influencers for both patients and dental teams. The time pressures for dental practices were identified as a major barrier. Some practical issues, such as procurement and stock supply, would need to be considered if the ENHANCE-D interventions were to be implemented in routine practice. Conclusion Primary dental care teams are well-placed to deliver smoking cessation interventions. However, a number of facilitators and deterrents have been identified and strategic changes are needed for successful implementation.
... 32 We speculate that our findings of reduced e-cigarette and NRT substitution in the group with lower SES might be because of individuals of lower SES being more price sensitive and e-cigarettes and NRT being more costly than comparable units of combustible cigarettes. 36 Individuals of lower SES also may not be aware of the potential benefits of switching to NRT and may not have the same access to NRT as more affluent individuals. Several possible policy changes that may help to increase familiarity with NRT products and address concerns individuals may have about the use of NRT include: (1) requiring the sale of NRT at every point of sale of cigarettes, (2) promoting quitting cigarettes using NRT or referral to a state smoker's quitline at places where people either smoke or buy cigarettes, and (3) having more educational materials about the benefits of quitting or distributing free NRT in communities of lower SES. ...
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Introduction Cigarette smoking accounts for >30% of the socioeconomic gap in life expectancy. Flavored restrictions claim to promote equity; however, no previous studies have compared the effect of cigarette and e-cigarette flavor restrictions among individuals who smoke with lower and higher socioeconomic status (SES). Aims and Methods In a between-group within-subject design, individuals with lower (n = 155) and higher (n = 125) SES completed hypothetical purchasing trials in the experimental tobacco marketplace (ETM). Conditions were presented in a 2 × 2 factorial design (cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted) with increasing cigarette prices across trials. Results Results show (1) SES differences in cigarette, e-cigarette, and NRT purchases under unrestricted policies, with lower SES showing higher cigarette demand and lower e-cigarette and NRT substitution than higher SES, (2) cigarette restrictions decreased cigarette and increased NRT purchases among lower SES, but no significant changes among higher SES, (3) decreased SES differences in cigarette demand under cigarette restrictions, but persistence under e-cigarette restrictions or their combination, (4) persistence of SES differences in e-cigarette purchases when all restrictions were enforced, and (5) waning of SES differences in NRT purchasing under all restrictions. Conclusions Flavor restrictions differentially affected individuals based on SES. Within-group comparisons demonstrated restrictions significantly impacted lower SES, but not higher SES. Between-group comparisons showed SES differences in cigarette purchasing decreased under cigarette restrictions, but persisted under e-cigarette-restrictions or their combination. Additionally, SES differences in NRT substitution decreased under flavor restrictions. These findings highlight the utility of the ETM to investigate SES disparities. Implications With increasing trends of socioeconomic differences in smoking prevalence and cessation rates, smoking-related health disparities are expected to continue to widen. Restricting menthol flavor in cigarettes while enhancing the availability and affordability of NRT have the potential to alleviate SES disparities in tobacco use, therefore, positively impacting health equity. However, this effect may depend on flavor availability in other tobacco products.
Article
Introduction 30 states enacted e-cigarette taxes by the end of 2023. E-cigarette tax schema in the USA vary, in contrast to cigarette taxes that are standardised as an excise tax amount per pack. Some states use excise taxes on liquid and containers, others wholesale sales taxes and others retail sales taxes. Increasingly, states are taxing open system and closed system products differently. It is therefore difficult to understand the relative magnitudes of these e-cigarette taxes and their size relative to cigarette taxes. Objective To update and publish a database of state and local quarterly e-cigarette tax rates from 2010 to 2023, standardised as the rate per millilitre of fluid, for both closed system and open system products. Methods Using Universal Product Code-level e-cigarette sales from the NielsenIQ Retail Scanner Data along with e-cigarette product characteristics collected from internet searches and visits to e-cigarette retailers, we develop a method to standardise e-cigarette tax rates as an equivalent average excise tax rate measured per millilitre of fluid. Results In 2023, the average American resided in a location with 3.21incigarettetaxesand3.21 in cigarette taxes and 0.49 in closed system e-cigarette taxes (per 0.7 fluid millilitre). Among the 10 states using segmented taxation for closed and open systems, the average open system e-cigarette tax was 85% lower. Conclusions The public availability of this updated database of state and local standardised e-cigarette tax rates will improve and expand research on effects of e-cigarette taxes on tobacco and related outcomes.
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Objective We examined the relationship in Australia from 2007 to 2020 between tobacco tax increases and use of cost-minimising behaviours (CMBs) when purchasing tobacco and: (1) tobacco expenditure and (2) smoking cessation attempts and quit success. Methods We used data collected from adults who smoked factory-made and/or roll-your-own (RYO) cigarettes in nine waves (2007–2020) of the International Tobacco Control Policy Evaluation Project Australia Survey (N sample =4975, N observations =10 474). CMBs included buying RYO tobacco, cartons, large-sized packs, economy packs, or tax avoidance/evasion, smoking reduction and e-cigarette use. Logistic regression, fit using generalised estimating equations, estimated the CMB-outcome association for quit attempts and quit success at the next wave follow-up (N subsample =2984, N observations =6843). Results Over half of respondents used a CMB for tobacco purchase (P-CMB) at baseline (57.1% in 2007–2008), increasing to 76.8% (2018) post-tax increases. Participating in any P-CMB was associated with having higher weekly tobacco expenditure. Engaging in any P-CMB was negatively associated with attempting to quit (aOR=0.82, 95% CI 0.69–0.98). Purchasing RYO tobacco or cartons was associated with making no quit attempts (aOR=0.66, 95% CI 0.52–0.83; aOR=0.72, 95% CI 0.59–0.89, respectively). Among respondents smoking cigarettes who made quit attempts, there were no significant associations between all P-CMBs and quit success. Neither smoking reduction nor vaping were significantly associated with quit attempts. Conclusion P - CMBs are associated with reduced smoking cessation. Reducing opportunities for industry to promote purchasing-related CMB options, such as by standardising pack sizes and reducing the price differential between RYO and manufactured cigarettes could increase the effectiveness of tax increases.
Article
Background: Studies have shown that food insecurity is associated with electronic vapor products (EVP) use in adults; however, an understanding of this relationship in adolescents is needed to inform prevention efforts in this age group. Aim: Examine the relationship of food insecurity with EVP use patterns, frequency and source of acquisition in high school students. Methods: This cross-sectional study used Youth Risk Behavior Survey (YRBS) 2019 data from states that incorporated the YRBS' optional food insecurity question. The data included 42,154 high school students with complete information on food insecurity and two EVP-related questions. Responses to EVP-related questions identified “ever users,” “current users,” “former users,” “current dual EVP-cigarette users,” and assessed “frequency of EVP use among current users” and “source of EVP acquisition.” Logistic regression examined associations of food insecurity with EVP-related outcomes. Results: The proportion of high school students who ever used EVP was 48.3% and the proportion of food-insecure students was about 12%. Food security status significantly differed by race/ethnicity of students, such that the proportion of food insecure students classified as “non-Hispanic White” was lower than the proportion of food secure students classified as “non-Hispanic White.” Food insecurity was significantly associated with greater odds of ever EVP use (odds ratio (OR) = 1.75; 95% confidence interval (CI) = (1.55, 1.96)), current EVP use (OR = 2.07; 95% CI = (1.80, 2.37); using never users as reference category) and current dual use of EVP and cigarettes (OR = 2.91; 95% CI = (2.38, 3.55)). Food insecurity also was associated with greater odds of current EVP use (OR = 1.54; 95% CI = (1.28, 1.84)) when former users were used as reference category. In current users, food insecurity was related to greater odds of daily EVP use (OR = 1.40; 95% CI = (1.14, 1.70)) compared to occasional use. Conclusions: Study findings imply that efforts targeting prevention/cessation of EVP use should consider reducing food insecurity in high school students.
Article
Introduction E‐cigarette use has rapidly increased amongst young people in Australia, however the prevalence of use amongst pregnant people is not known. The aim of this study was to examine the prevalence of e‐cigarette use and dual use of e‐cigarettes and tobacco cigarettes, characteristics associated with use and reasons for use amongst a sample of pregnant Australian people attending public antenatal clinics. Methods A cross‐sectional survey was conducted with 4024 pregnant people attending antenatal appointments, between July 2021 and December 2022, in one local health district in New South Wales, Australia. Main outcome measures were current use of e‐cigarettes, dual use with tobacco cigarettes, participant characteristics associated with use and reasons for use. Results 1.24% of pregnant people used e‐cigarettes, 34% of these were dual smokers. Being a current smoker (OR 39.49; 95% CI 9.99–156.21) or ex‐smoker (OR 29.86; 95% CI 8.75–101.95) were associated with e‐cigarette use. Quitting smoking was the most reported reason for use (52%). Discussion and Conclusions This study is the first to report on the prevalence of e‐cigarette use amongst pregnant people in Australia. We found that a small proportion of pregnant people use e‐cigarettes and that many are dual users or ex‐smokers. E‐cigarette use and rates of dual use in pregnancy in Australia appear lower than internationally, however they are similarly being used as a smoking‐cessation aid by many. As regulatory environments relating to e‐cigarette access change in Australia, large‐scale studies are required to continue to monitor e‐cigarette use and dual use in pregnancy.
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Unhealthy behaviors such as poor diet and tobacco use contribute to disease burden and escalating healthcare costs. This paper evaluates potential savings from people adopting reduced risk behaviors in Mexico. Using the Preventable Risk Integrated Model, we compare actual consumption in 2016 (baseline) to optimal intake following WHO guidelines (counterfactual) for salt, fiber, fruit/vegetables, and fat to estimate reductions in coronary, cerebrovascular, cancer, diabetes and hypertensive diseases. We also model 50% of smokers switching to e-cigarettes/heated tobacco with 65–97% lower disease risk. Results indicate over 650,000 preventable cases annually, mostly from diet changes (fruits/vegetables, fat, salt). Healthcare cost savings reach 3.4billionUSD;3.4 billion USD; 2.8 billion from nutrition and 0.3billionfromsmokingsubstitution.Fruit/vegetableintakeandreducedfatconferover0.3 billion from smoking substitution. Fruit/vegetable intake and reduced fat confer over 1 billion savings each. Salt and fiber also contribute significantly. Adding smoking transitions provides further savings. Shifting Mexicans towards healthier diets and alternative nicotine products could substantially lower disease burden and healthcare costs. These findings underscore the economic imperative of promoting reduced-risk behaviors through public health policies.
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Aim: This study examines where vapers purchase their vaping refills in countries having different regulations over such devices, Canada (CA), the United States (US), England (EN), and Australia (AU). Methods: Data were available from 1899 current adult daily and weekly vapers who participated in the 2016 (Wave 1) International Tobacco Control Four Country Smoking and Vaping. The outcome was purchase location of vaping supplies (online, vape shop, other). Adjusted odds ratios and 95% confidence intervals were reported for between country comparisons. Results: Overall, 41.4% of current vapers bought their vaping products from vape shops, 27.5% bought them online, and 31.1% from other retail locations. The vast majority of vapers (91.1%) reported using nicotine-containing e-liquids. In AU, vapers were more likely to buy online vs other locations compared to CA (OR = 6.4, 2.3–17.9), the US (OR = 4.1, 1.54–10.7), and EN (OR = 7.9, 2.9–21.8). In the US, they were more likely to buy from vape shops (OR = 3.3, 1.8–6.2) or online (OR = 1.9, 1.0–3.8) vs other retail locations when compared to those in EN. In CA, vapers were more likely to purchase at vape shops than at other retail locations when compared to vapers in EN (5.9, 3.2–10.9) and the US (1.87, 1.0–3.1). Conclusions: The regulatory environment and enforcement of such regulations appear to influence the location where vapers buy their vaping products. In AU, banning the retail sale of nicotine vaping products has led vapers to rely mainly on online purchasing sources, whereas the lack of enforcement of the same regulation in CA has allowed specialty vape shops to flourish.
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E-cigarettes are promoted as healthier alternatives to conventional cigarettes. Many cigarette smokers use both products. It is unknown whether the additional use of e-cigarettes among cigarette smokers (dual users) is associated with reduced exposure to tobacco-related health risks. Cross-sectional analysis was performed using baseline data from the Health eHeart Study, among English-speaking adults, mostly from the United States. Cigarette use (# cigarettes/day) and/or e-cigarette use (# days, # cartridges, and # puffs) were compared between cigarette only users vs. dual users. Additionally, we examined cardiopulmonary symptoms/ conditions across product use: no product (neither), e-cigarettes only, cigarettes only, and dual use. Among 39,747 participants, 573 (1.4%) reported e-cigarette only use, 1,693 (4.3%) reported cigarette only use, and 514 (1.3%) dual use. Dual users, compared to cigarette only users, reported a greater median (IQR) number of cigarettes per day, 10.0 (4.0–20.0) vs. 9.0 (3.0–15.0) (p < .0001), a lower (worse) median (IQR) SF-12 general health score, 3.3 (2.8–3.8) vs. 3.5 (2.8–3.9) (p = .0014), and a higher (worse) median (IQR) breathing difficulty score in the past month, 2.0 (1.0–2.0) vs. 1.0 (1.0–2.0) (p = .001). Of the 19 cardiopulmonary symptoms/ conditions, having a history of arrhythmia was significantly different between cigarette only users (14.2%) and dual users (17.8%) (p = .02). In this sample, dual use was not associated with reduced exposure to either (i) cigarettes, compared to cigarette only users or (ii) e-cigarettes, compared to e-cigarette only users. E-cigarette only use, compared to no product use, was associated with lower general health scores, higher breathing difficulty scores (typically and past month), and greater proportions of those who responded ‘yes’ to having chest pain, palpitations, coronary heart disease, arrhythmia, COPD, and asthma. These data suggest the added use of e-cigarettes alone may have contributed to cardiopulmonary health risks particularly respiratory health risks.
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Background While national surveys showed declines in e-cigarette use in the USA between 2015 and 2016, recent reports indicate that JUUL, a sleekly designed e-cigarette that looks like a USB drive, is increasingly being used by youth and young adults. However, the extent of JUUL’s growth and its marketing strategy have not been systematically examined. Methods A variety of data sources were used to examine JUUL retail sales in the USA and its marketing and promotion. Retail store scanner data were used to capture the retail sales of JUUL and other major e-cigarette brands for the period 2011–2017. A list of JUUL-related keywords was used to identify JUUL-related tweets on Twitter; to identify JUUL-related posts, hashtags and accounts on Instagram and to identify JUUL-related videos on YouTube. Results In the short 3-year period 2015–2017, JUUL has transformed from a little-known brand with minimum sales into the largest retail e-cigarette brand in the USA, lifting sales of the entire e-cigarette category. Its US$150 million retail sales in the last quarter of 2017 accounted for about 40% of e-cigarette retail market share. While marketing expenditures for JUUL were moderate, the sales growth of JUUL was accompanied by a variety of innovative, engaging and wide-reaching campaigns on Twitter, Instagram and YouTube, conducted by JUUL and its affiliated marketers. Conclusions The discrepancies between e-cigarette sales data and the prevalence of e-cigarette use from surveys highlight the challenges in tracking and understanding the use of new and emerging tobacco products. In a rapidly changing media environment, where successful and influential marketing campaigns can be conducted on social media at little cost, marketing expenditures alone may not fully capture the influence, reach and engagement of tobacco marketing.
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Introduction: Raising tobacco prices is the most effective population-level intervention for reducing smoking, but this is undermined by the availability of cheap tobacco. This study monitors trends in cheap tobacco use among adult smokers in the UK between 2002-2014 via changes in product type, purchase source, and prices paid. Methods: Weighted data from 10 waves of the International Tobacco Control policy evaluation study were used. This is a longitudinal cohort study of adult smokers with replenishment; 6169 participants provided 15812 responses. Analyses contrasted 1) product type: roll-your-own (RYO) tobacco, factory made packs (FM-P), and cartons (FM-C); 2) purchase source: UK store-based sources (e.g. supermarkets, convenience stores) with non-UK/ non-store sources representing tax avoidance/ evasion (e.g. outside the UK, duty free, informal sellers); and 3) prices paid (inflation-adjusted to 2014 values). Generalised Estimating Equations tested linear changes over time. Results: 1) RYO use increased significantly over time as FM decreased. 2) UK store-based sources constituted approximately 80% of purchases over time, with no significant increases in tax avoidance/ evasion. 3) Median RYO prices were less than half that of FM, with FM-C cheaper than FM-P. Non-UK/ non-store sources were cheapest. Price increases of all three product types from UK store-based sources from 2002 - 2014 were statistically significant, but not substantial. Wide (and increasing for FM-P) price ranges meant each product type could be purchased in 2014 at prices below their 2002 medians from UK store-based sources. Conclusions: Options exist driving UK smokers to minimise their tobacco expenditure; smokers do so largely by purchasing cheap tobacco products from UK stores. Implications: The effectiveness of price increases as a deterrent to smoking is being undermined by the availability of cheap tobacco such as roll-your-own tobacco and cartons of packs of factory-made cigarettes. Wide price ranges allowed smokers in 2014 to easily obtain cigarettes at prices comparable to 12 years prior, without resorting to tax avoidance or evasion. UK store-based sources accounted for 80% or more of all tobacco purchases between 2002-2014, suggesting little change in tax avoidance or evasion over time. There was a widening price range between the cheapest and most expensive factory-made cigarettes.
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Background: Some scholars suggest that price differences between combustible cigarettes and e-cigarettes could be effective in moving current combustible smokers to e-cigarettes, which could reduce tobacco-related death and disease. Currently, in most jurisdictions, e-cigarettes are not subject to the same excise taxes as combustible cigarettes, potentially providing the category with a price advantage over combustible cigarettes. This paper tests whether e-cigarettes tax advantage has translated into a price advantage. Methods: In a sample of 45 countries, the price of combustible cigarettes, disposable e-cigarettes and rechargeable cigarettes were compared. Results: Comparable units of combustible cigarettes cost less than disposable e-cigarettes in almost every country in the sample. While the e-liquids consumed in rechargeable e-cigarettes might cost less per comparable unit than combustible cigarettes, the initial cost to purchase a rechargeable e-cigarette presents a significant cost barrier to switching from smoking to vaping. Discussion: Existing prices of e-cigarettes are generally much higher than of combustible cigarettes. If policymakers wish to tax e-cigarettes less than combustibles, forceful policy action-almost certainly through excise taxation-must raise the price of combustible cigarettes beyond the price of using e-cigarettes.
Article
Background/aims: The expense associated with using non-combustible nicotine products as an alternative to smoking may deter smoking reduction or cessation. This study aimed to estimate (i) how much adults in England spend each week on smoking and alternative nicotine products and (ii) the potential cost saving that could be achieved by switching from smoking to using an alternative nicotine delivery product. Design/setting: Data came from September to November 2018 waves of the Smoking Toolkit Study, a series of national household surveys of the adult population in England. Participants: A total of 859 adults (≥16 years) who reported current smoking or current use of an alternative nicotine product. Measurements: Participants reported their average weekly expenditure on smoking and alternative nicotine products (nicotine replacement therapy (NRT) or e-cigarettes). Findings: Current smokers who did not use any alternative nicotine delivery products (n=602) reported spending on average £23.09 (95%CI £21.64-24.54) on smoking each week. Ex-smokers who used alternative nicotine products (n=91) reported spending on average £8.59 (95% CI £6.80-10.39) on these products each week; £8.03 (95%CI £6.03-10.03) on e-cigarettes and £10.05 (95%CI £5.62-14.47) on NRT. People who both smoked and used alternative nicotine products (dual users, n=166) spent on average £24.54 (95%CI £21.78-27.29) on smoking and £7.49 (95%CI £6.00-8.99) on alternative nicotine products each week. Expenditure on smoking was higher among heavier, more addicted smokers and lower among those with routine/manual occupations, non-daily smokers, and roll-your-own tobacco users. Expenditure on e-cigarettes was higher among men, users from central and southern vs. northern England, and smokers who had tried to quit in the past year, and lower among current smokers. Expenditure on NRT was lower among roll-your-own tobacco users. Conclusions: In England, expenditure among e-cigarette and nicotine replacement therapy (NRT) users is approximately one third of the expenditure of smokers. The average smoker may save an estimated £15 per week by switching completely to e-cigarettes or £13 per week by switching to NRT, although this is likely to differ according to individual usage patterns.
Article
Aims To determine if there are associations between changes in the explicit (i.e., price) and implicit (i.e., use restrictions in public places) costs of cigarettes and nicotine vaping products (NVPs) and their use patterns in the United States. Methods Data came from the Wave 1 (2016) US data of the ITC Four Country Smoking and Vaping Survey (ITC US 4CV1) and Nielsen Scanner Track database. A multiple logistic regression model was applied to estimate the likelihoods of NVP use (vaping at least monthly), cigarette/NVP concurrent use (vaping and smoking at least monthly), and switch from cigarettes to NVPs (had quit smoking < 24 months and currently vape) among ever smokers, conditioning upon cigarette/NVP prices, use restrictions and socio‐demographics. Results Living in places where vaping is allowed in smoke‐free areas was significantly associated with an increase in the likelihood of vaping (Marginal Effect, M.E. = 0.17; p<0.05) and the concurrent use of cigarettes and NVPs (M.E. = 0.11; p<0.05). Higher NVP prices were associated with decreased likelihood of NVP use, concurrent use, and complete switch (P>0.05). Higher cigarette prices were associated with greater likelihood of cigarette and NVP concurrent use (P>0.05). Working in places where vaping is banned is associated with lower likelihood of vaping and NVP and cigarette concurrent use (P>0.05). Conclusions Higher prices for nicotine vaping products (NVPs) and vaping restrictions in public places are associated with less NVP use and less concurrent use of vaping and smoking. Public policies that increase prices for vaping devices and supplies (i.e., regulations, taxes) and restrict where vaping is allowed are likely to suppress vaping.
Article
Aim To describe the methods of the 2016 International Tobacco Control (ITC) Four Country Smoking and Vaping (4CV) Survey, conducted in 2016 in Australia (AU), Canada (CA), England (EN), and the United States (US). Methods The respondents were cigarette smokers, former smokers (quit within the previous two years), and at‐least‐weekly vapers, aged 18 and older. Eligible cohort members from the ITC Four Country Survey (4C) were retained. New respondents were sampled by commercial firms from their panels. Where possible, ages 18‐24 and vapers were over‐sampled. Data were collected online, and respondents were remunerated. Survey weights were calibrated to benchmarks from nationally representative surveys. Results Response rates by country for new recruits once invited ranged from 15.2% to 49.6%; cooperation rates were above 90%. Retention rates from the 4C cohort ranged from 35.7% to 44.2%. Sample sizes for smokers/former smokers were 1504 in AU, 3006 in CA, 3773 in EN, and 2239 in the US. Sample sizes for additional vapers were 727 in CA, 551 in EN, and 494 in the US. Conclusion The International Tobacco Control Four Country Smoking and Vaping Survey design and data collection methods allow analyses to examine prospectively the use of cigarettes and nicotine vaping products in jurisdictions with different regulatory policies. The effects on the sampling designs and response quality of recruiting the respondents from commercial panels are mitigated by the use of demographic and geographic quotas in sampling; by quality control measures; and by the construction of survey weights taking into account smoking/vaping status, sex, age, education, and geography.
Article
This study estimated a system of demand for cigarettes, little cigars/cigarillos, large cigars, e-cigarettes, smokeless tobacco, and loose smoking tobacco using market-level scanner data for convenience stores. We found that the unconditional own-price elasticities for the six categories are -1.188, -1.428, -1.501, -2.054, -0.532, and -1.678, respectively. Several price substitute (e.g., cigarettes and e-cigarettes) and complement (e.g., cigarettes and smokeless tobacco) relationships were identified. Magazine and television advertising increased demand for e-cigarettes, and magazine advertising increased demand for smokeless tobacco and had spillover effects on demand for other tobacco products. We also reported the elasticities by U.S. census regions and market size. These results may have important policy implications, especially viewed in the context of the rise of electronic cigarettes and the potential for harm reduction if combustible tobacco users switch to non-combustible tobacco products. Copyright © 2016 John Wiley & Sons, Ltd.