Vaporised Nicotine Product Initiation Among Youth in the US, Canada, and England: Methods to Predict Uptake and Policy Efficacy

PI: Dr. David Hammond

http://davidhammond.ca/projects/e-cigarettes/itc-youth-tobacco-ecig/

For the past century, cigarettes have been the dominant form of nicotine delivery in Western countries. However, the global nicotine market is rapidly evolving due to the emergence of vaporised nicotine products (VNPs). VNPs have potential benefits in regards to promoting cessation among current smokers; however, there is widespread concern about the use of VNPs among non-smokers in ways that may expand the nicotine market and undermine tobacco control efforts. Indeed, rates of VNP use among youth have risen dramatically in countries such as the US, Canada, and England.

Regulators are considering a broad range of policies to minimise youth uptake of VNPs, particularly in regards to restrictions on promotion and product attributes that may enhance appeal among youth. Given the speed with which the VNP market is evolving, there is an urgent need to develop the evidence base to inform these policies. However, the methodology required to test the efficacy of regulating promotions and VN products is lacking. Even in the area of cigarettes and other tobacco products, most policy research continues to be conducted on smokers, and after only policies have already been implemented. There is a need to develop a framework for testing the potential efficacy of policies—such as health warnings, flavour bans, and advertising restrictions—prior to their implementation and among the critical demographic of youth, when uptake typically occurs.

The overall objective of the current project is to develop a framework for testing the efficacy of policy measures in preventing VNP use among youth. Cohorts of youth will be recruited to prospectively assess trial and uptake of VNPs at baseline and 12-month follow-up. Experimental methods will be incorporated into the baseline survey to examine how various policies might influence demand and to empirically test which method is best able to predict VNP trial and current use at follow-up.

Aim 1: To examine international variations in VNP initiation among youth.

Prospective cohort surveys will be conducted with 4,500 youth at baseline and at 12-month follow-up in each of three countries with very different policy and product environments for VNPs: 1) Canada, in which VNPs containing nicotine are prohibited; 2) the US, in which VNPs are legal with few marketing and sales restrictions; and, 3) England, where conventional VNPs will be subject to greater restrictions, but can also be licensed as medicines. The study will examine whether overall rates of VNP initiation differ between these jurisdictions, as well as correlates of initiation.

Aim 2: To estimate the influence of policy measures on consumer demand for VNPs among youth.

At baseline, participants will be randomised to complete one of two established measures of consumer demand from the fields of marketing and behavioural economics: a discrete choice experiment or an “auction” experiment. Measures of consumer demand will be administered using an experimental design to examine how demand is influenced by eight policy-relevant attributes: product type, nicotine content level, flavour, branding, price, advertisements, health warnings, and modified risk claims on packaging. The discrete choice experiment and auction experiment will estimate the extent to which each of these factors alters demand among youth.

Aim 3: To develop the methodological framework for policy evaluation and pre-market testing of nicotine products.

The study will examine the extent to which measures of demand from the discrete choice experiments and “auction” experiments predicts actual VNP trial and current use at 12-month follow-up in the prospective surveys. The study will compare the predictive validity of these two methods with conventional measures of VNP susceptibility. Therefore, the study will help to validate these methods with respect to assessing consumer demand for novel products, particularly with respect to the effects of specific product attributes and policy measures.