Estimating Demand for Alternatives to Cigarettes with Online Purchase Tasks

Autor: Andrew Hyland, Richard J O'Connor, K. Michael Cummings, Kristie M. June, Maansi Bansal-Travers, Matthew C. Rousu, James F. Thrasher
Rok vydání: 2014
Předmět:
Zdroj: American Journal of Health Behavior. 38:103-113
ISSN: 1945-7359
1087-3244
DOI: 10.5993/ajhb.38.1.11
Popis: Promotion of reduced-harm alternatives to cigarettes has increased since the 1990s. Initially, these products were modified cigarettes that were poorly received by consumers and offered relatively little health risk reduction potential.1 Since the early 2000s there has been a proliferation of novel types of smokeless tobacco (ST) products, including snus, a product patterned on low-nitrosamine products available in Sweden. This marketing coincided with the emergence of Swedish research suggesting reductions in smoking rates and cancer mortality could be attributed to use of snus in lieu of cigarettes.2–4 Manufacturers such as Star Tobacco have marketed other, more processed oral tobacco products like Ariva, which is comprised of finely milled low-nitrosamine tobacco compressed into a lozenge. This concept was adopted by RJ Reynolds with its line of dissolvable products, including Camel Orbs, Sticks, and Strips. Philip Morris introduced a variant on this concept in 2011 with Marlboro and Skoal Sticks, where finely ground tobacco was applied to toothpick-like sticks for oral use. In spite of this proliferation of novel ST products, little is known about consumer perceptions and use of these products. Some public health advocates have pointed to oral ST products as having the potential for harm reduction among smokers who might otherwise not quit tobacco, but who would replace smoking cigarettes with oral ST.5–8 However, others have raised concerns that any individual health benefits incurred by these “switchers” could be offset by increased use of ST among youth and former smokers.9 There is also concern that promoting alternative tobacco products could lead to a renormalization of tobacco use with unknown consequences. A basic question arises regarding the promotion and public health benefits of ST products: Would smokers who have not quit smoking despite rising prices, increasing social isolation, and clear health risks be willing to adopt an alternative product on a permanent basis? Thus far, ads for these novel alternative products have tended to endorse the convenience of the product and ability to use the product in places where smoking is no longer permitted, but ads have avoided making explicit health claims associated with use.10 There is no debate that exposure to tobacco advertising influences product choice,11 but it is less clear whether and how specific marketing messages will influence current cigarette smokers to switch to ST as an alternative nicotine delivery mechanism. Previous surveys have found that smokers are interested in using alternatives to cigarettes.12–14 However, self-reported interest in ST product trial may not predict use, and, indeed, in test markets where novel ST products have been made available, trial and adoption rates appear to be low.15 Perceived relative risk may play a role. Despite the evidence of lower individual-level risks, evidence shows that smokers misperceive the risks of ST, nicotine, and smoking. Borland et al.16 found that only 1 in 6 smokers believed ST to be less harmful than cigarettes, while only 1 in 3 believed nicotine replacement therapy (NRT) was much less harmful than cigarettes, with no changes in the prevalence of these misperceptions over the period from 2002 to 2009. Many smokers wrongly believe nicotine to be a cause of cancer.16–18 Both Cummings 19 and Kozlowski & Edwards 20 note that smokers require accurate, science-based information about the relative risks of tobacco and nicotine products; information that could then possibly drive them toward less harmful products.21 Another factor may be self-identification with smoking per se – that is, smokers may not see themselves as the ‘type of person’ who uses smokeless tobacco, even novel forms, and prefer the perceived flexibility of the cigarette.22 So while smokers may express interest in less harmful alternatives to cigarettes in the abstract, this interest may not translate into actual use, and simply asking questions about intentions and interest may not provide strong evidence of the extent to which smokers would be willing to move from cigarettes to a safer alternative nicotine delivery product. One way to estimate smokers’ demand for ST products is through the use of purchase tasks, which allow estimation of the reinforcing properties of different products.23–25 In these tasks, subjects are asked to project how much of a given product they would use across a range of unit prices, assuming it were the only product available to them. Few and colleagues 26 have shown this measure is stable in the short term as an estimate of cigarette demand. The simulated purchase task method generates estimates of demand elasticity and maximum consumption for each product in isolation – indeed, the task instructs participants to imagine they “have no access to cigarettes or nicotine products other than those offered…”.23 So, while the tasks give insight into the demand for each product individually, the ability of a purchase task to directly address the questions of whether smokers would substitute ST for cigarettes is limited, especially given the reality that both products are concurrently available. To address the issue of concurrent availability, economists employ a measure referred to as cross-price elasticity of demand (CPE), which captures change in use of one product given the change in price of another. As used in the drug abuse liability literature, CPE has typically been assessed by offering an alternative reinforcer at a fixed cost while varying the cost of the primary reinforcer.27–30 An alternative (ie, oral tobacco) would be considered a substitute if its consumption rises in response to increasing cost of the primary product (ie, cigarettes). An alternative would be considered a complement if its consumption drops in response to increasing cost of the primary product. Both the demand and CPE tasks have been found valid as well as temporally stable in small-sample studies.23,26 Bidwell et al also demonstrates behavioral validation of these methods among adolescent smokers31. MacKillop further adds to these implications highlighting that demand curves, in particular, are sensitive to price32 and support craving and motivation patterns for addictive drugs 33. This study first tests whether exposure to current examples of ST advertising influence demand for ST products in a group of current smokers. If the ads appeal to smokers and encourage them to consider switching from cigarettes to ST products, this would suggest that marketing campaigns that do not explicitly reference the potential health benefits of ST might nonetheless promote harm reduction. Second, the study compares smoker demand for four types of nicotine products – cigarettes, snus, dissolvables, and nicotine lozenges – using purchase task-based estimates of demand elasticity, peak consumption, and cross-price elasticity.23 In this way, we may be able to estimate the extent to which smokers viewed different oral tobacco products as acceptable substitutes for the cigarettes they smoke.
Databáze: OpenAIRE
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