Association of e-cigarette advertising with e-cigarette and cigarette use among US adults.

AIMS: To estimate the association of e-cigarette advertisement exposure with e-cigarette and cigarette use behavior among US adults. DESIGN: Data from the 2013-14 National Adult Tobacco Survey (NATS) were linked to Kantar Media and National Consumer Study data to construct measures of e-cigarette advertisements on TV and in magazines. The relationship between advertisement measures and outcomes was estimated using logistic and Poisson regressions, controlling for socio-demographics, state cigarette taxes and state and year fixed-effects. SETTING: United States. PARTICIPANTS/CASES: A total of 98 746 adults aged ≥ 18 years who responded to the 2013-14 NATS. MEASUREMENTS: The independent variables of interest were the number of e-cigarette advertisements in magazines to which an adult was exposed in the past 6 months and the number of e-cigarette advertisements on TV to which an adult was exposed in the past 6 months. Outcomes were awareness of e-cigarettes, ever e-cigarette use, current e-cigarette use, current cigarette use and number of cigarettes smoked per month. FINDINGS: Exposure to one additional e-cigarette advertisement on TV was associated with a 0.18, 0.13 and 0.03 percentage point increase, respectively, in awareness, ever use and current use of e-cigarettes among all adults (P < 0.05). This exposure also was associated with a 0.11 percentage point increase in current cigarette use among all adults and an increase in cigarette consumption of 2.24 cigarettes per month among adults aged ≥ 45 (P < 0.05). CONCLUSIONS: Exposure to e-cigarette advertising appears to be positively associated with the use of e-cigarettes and cigarettes among adults of all ages, and with increased cigarette consumption among older adults.

E-Cigarettes and Adult Smoking: Evidence from Minnesota.

E-cigarettes provide nicotine in a vapor form, which is considered less harmful than the smoke from combustible cigarettes because it does not contain the toxins that are found in tobacco smoke. E-cigarettes may be effective in helping smokers to quit or they might simply provide smokers a method of bypassing smoking restrictions. There is very little causal evidence to date on how e-cigarette use impacts smoking cessation among adults. Minnesota was the first to impose a tax on e-cigarettes. This tax provides a plausibly exogenous deterrent to e-cigarette use. We utilize data from the Current Population Survey Tobacco Use Supplements from 1992 to 2015 to assess how the Minnesota tax increase impacted smoking cessation among adult smokers. Estimates suggest that the e-cigarette tax increased adult smoking and reduced smoking cessation in Minnesota, relative to the control group, and imply a cross elasticity of current smoking participation with respect to e-cigarette prices of 0.13. Our results suggest that in the sample period about 32,400 additional adult smokers would have quit smoking in Minnesota in the absence of the tax. If this tax were imposed on a national level about 1.8 million smokers would be deterred from quitting in a ten year period. The taxation of e-cigarettes at the same rate as cigarettes could deter more than 2.75 million smokers nationally from quitting in the same period. The public health benefits of not taxing e-cigarettes, however, must be weighed against effects of this decision on efforts to reduce vaping by youth.

News that Takes Your Breath Away: Risk Perceptions During an Outbreak of Vaping-related Lung Injuries.

We study the impact of new information on people's perceptions of the risks of e-cigarettes. In September 2019 the U.S. experienced an outbreak of e-cigarette, or vaping, associated lung injuries (EVALI). The EVALI outbreak created an information shock, which was followed by additional new information in a later CDC recommendation. We use data on consumer risk perceptions from two sets of surveys conducted before (HINTS survey data) and during the EVALI outbreak (Google Survey data). The empirical model examines changes in risk perceptions during the early crisis period when the CDC was warning consumers that they should avoid all vaping products and during a later period when the message was refined and focused on a narrower set of illegal vaping products that contain THC (the main psychoactive compound in marijuana). Econometric results suggest that the immediate impact of the first information shock was to significantly increase the fraction of respondents who perceived e-cigarettes as more harmful than smoking. As the outbreak subsided and the CDC recommendation changed to emphasize the role of THC e-cigarette products, e-cigarette risk perceptions were only partially revised downwards. Individuals who had higher risk perceptions showed a weaker response to the first information shock but were more likely to later revise their risk perceptions downwards. We conclude the paper by discussing the public policy issues that stem from having risk perceptions of e-cigarette relative to combustible cigarettes remain at these elevated levels where a substantial portion of consumers believe that e-cigarettes are more harmful than cigarettes.

The earned income tax credit and infant health revisited.

Hoynes, Miller, and Simon (2015), henceforth HMS, report that the national expansion of the Earned Income Tax Credit (EITC) is associated with decreases in low birth weight. We question their findings. HMS's difference-in-differences estimates are unidentified in some comparisons, while failed placebo tests undermine others. Their effects lack a plausible mechanism as the association between the EITC and prenatal smoking also fails placebo tests. We contend that the waning of the crack epidemic is a possible confound, but we show that any number of policies directed at poor women also eliminate the effect of the EITC when aggregated to the national level. Identifying small, causal effects of a national policy at a single point in time is exceedingly challenging.

Does e-cigarette advertising encourage adult smokers to quit?

We provide the first causal evidence on whether e-cigarette advertising on television and in magazines encourages adult smokers to quit. We find the answer to be yes for TV advertising but no for magazine advertising. Our results indicate that a policy banning TV advertising of e-cigs would have reduced the number of smokers who quit in the recent past by approximately 3%. If the FDA were not considering regulations and mandates, e-cig ads might have reached the number of nicotine replacement therapy TV ads during that period. That would have increased the number of smokers who quit by around 10%.

U.S. Demand for Tobacco Products in a System Framework.

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.

Effect of price changes in little cigars and cigarettes on little cigar sales: USA, Q4 2011-Q4 2013.

INTRODUCTION: Little cigars are comparable to cigarettes in terms of shape, size, filters and packaging. Disproportionate tobacco excise taxes, which directly affect purchase price, may lead consumers to substitute cigarettes with less expensive little cigars. This study estimated the effects of little cigar and cigarette prices on little cigar sales. METHODS: Sales data from a customised retail scanner database were used to model a log-log equation to infer own-price and cross-price elasticity of demand for little cigars relative to little cigar and cigarette prices, respectively, from quarter 4 of 2011 to quarter 4 of 2013. Data were available for convenience stores (C-stores) (n=29 states); food, drug and mass merchandisers (FDMs) (n=44 states); and C-stores and FDMs combined (n=27 states). The dependent variable was per capita little cigar pack sales, and key independent variables were the price index for little cigars and cigarettes. RESULTS: A 10% increase in little cigar price was associated with a 25% (p<0.01) decrease in little cigar sales in C-stores alone, and a 31.7% (p<0.01) decrease in C-stores and FDMs combined. A 10% increase in cigarette price was associated with a 21.5% (p<0.05) increase in little cigar sales in C-stores, and a 27.3% (p<0.01) increase in C-stores and FDMs combined. CONCLUSIONS: Our results suggest that US cigarette smokers are avoiding the high cost of cigarettes by switching to lower priced little cigars. Increasing and equalising prices among comparable products, like cigarettes and little cigars, may motivate cost-conscious smokers to quit.

National and State-Specific Sales and Prices for Electronic Cigarettes-U.S., 2012-2013.

INTRODUCTION: The growing market for electronic cigarettes (e-cigarettes) has been widely reported in the media, but very little objective data exist in the scientific literature, and no data have been published on state-specific trends in prices or sales. Our objective is to assess state-specific annual sales and average prices for e-cigarettes in the U.S. METHODS: Commercial retail scanner data were used to assess total dollar sales and average price per unit for disposable e-cigarettes, starter kits, and cartridge refills for selected states and the total U.S. during 2012-2013. Data were analyzed in 2014. Data were available for convenience stores (29 states) and food, drug, and mass merchandisers (44 states). RESULTS: In convenience stores, dollar sales increased markedly during 2012-2013: 320.8% for disposable e-cigarettes, 72.4% for starter kits, and 82% for cartridges. In food, drug, and mass merchandisers, dollar sales increased 49.5% for disposable e-cigarettes, 89.4% for starter kits, and 126.2% for cartridges. Average prices across all product categories increased in convenience stores and decreased in food, drug, and mass merchandisers. Sales and prices varied substantially across states included in the analyses. CONCLUSIONS: Sales of all e-cigarette device types grew considerably in convenience stores and food, drug, and mass merchandisers during 2012-2013. The market for e-cigarettes is growing rapidly, resulting in dynamic sales and price changes that vary across the U.S. Continued state-specific surveillance of the e-cigarette market is warranted.

The effect of exposure to media campaign messages on adult cessation.

INTRODUCTION: Numerous studies have examined the relationship between antitobacco mass-media campaigns and quit attempts. However, less is known about the effect of these campaigns on relapse. This paper evaluates the effect of media exposure on smokers' quit attempts and relapse. METHODS: We used data from the Florida Adult Cohort Survey, a telephone follow-up survey of adult smokers and recent quitters, who completed the Florida Adult Tobacco Survey. For this study, 1823 unique smokers and recent quitters from baseline first observed between July 2008 and October 2012 were surveyed through up to seven follow-up interviews between October 2009 and October 2013. Media exposure during this period primarily represents exposure to Florida's Tobacco Free Florida (TFF) campaign, although it also includes exposure to the Centers for Disease Control and Prevention's Tips From Former Smokers media campaign in 2012-2013. A multiple-spell discrete-time survival model was estimated using logistic regression. Each spell represents a quit attempt or relapse event. RESULTS: The odds of the first observed quit attempt are higher at higher levels of target rating points (TRPs) (aOR=1.02, p=0.023). The odds ratio for relapse and second quit and second relapse was not statistically significant. CONCLUSIONS: The results suggest that exposure to media campaign messages in Florida has led to increases in quit attempts. Although the estimates were not statistically significant for relapse or the second spell of quit attempts or relapse, the results suggest that media messages might also influence subsequent quit attempts or relapses after an initial quit attempt.

Crowdsourcing data collection of the retail tobacco environment: case study comparing data from crowdsourced workers to trained data collectors.

OBJECTIVE: To assess whether crowdsourcing is a viable option for conducting surveillance of point of sale (POS) tobacco marketing practices. METHODS: We posted jobs to an online crowdsourcing platform to audit 194 Florida licensed tobacco retailers over a 3-week period. During the same period, trained data collectors conducted audits at the same retail locations. Data were collected on cigarette advertising, cigarette promotions and product availability (electronic cigarettes, snus and dissolvables). We compared data collected by crowdsourced workers and trained staff and computed frequencies, percent agreement and inter-rater reliability. Photographs of e-cigarettes and exterior cigarette advertisements submitted by crowdsourced workers were used to validate responses. RESULTS: Inter-rater reliability between crowdsourced and trained data collectors was moderate to high for coding exterior cigarette advertisements, product availability and some tobacco promotions, but poor to fair when coding presence of sales and interior cigarette advertisements. Photos submitted by crowdsourced workers confirmed e-cigarette availability that was missed by trained data collectors in three stores. CONCLUSIONS: Crowdsourcing may be a promising form of data collection for some POS tobacco measures. Future studies should examine the cost-effectiveness of crowdsourcing compared with traditional trained data collectors and assess which POS measures are most amenable to crowdsourcing.

Public and policy maker support for point-of-sale tobacco policies in New York.

PURPOSE: To compare public and policy maker support for three point-of-sale tobacco policies. DESIGN: Two cross-sectional surveys--one of the public from the New York Adult Tobacco Survey and one of policy makers from the Local Opinion Leader Survey; both collected and analyzed in 2011. SETTING: Tobacco control programs focus on educating the public and policy makers about tobacco control policy solutions. SUBJECTS: Six hundred seventy-six county-level legislators in New York's 62 counties and New York City's five boroughs (response rate: 59%); 7439 New York residents aged 18 or older. Landline response rates: 20.2% to 22%. Cell phone response rates: 9.2% to 11.1%. MEASURES: Gender, age, smoking status, presence of a child aged 18 years or younger in the household, county of residence, and policy maker and public support for three potential policy solutions to point-of-sale tobacco marketing. ANALYSIS: t-tests to compare the demographic makeup for the two samples. Adjusted Wald tests to test for differences in policy support between samples. RESULTS: The public was significantly more supportive of point-of-sale policy solutions than were policy makers: cap on retailers (48.0% vs. 19.2%, respectively); ban on sales at pharmacies (49.1% vs. 38.8%); and ban on retailers near schools (53.3% vs. 42.5%). LIMITATIONS: cross-sectional data, sociodemographic differences, and variations in item wording. CONCLUSIONS: Tobacco control programs need to include information about implementation, enforcement, and potential effects on multiple constituencies (including businesses) in their efforts to educate policy makers about point-of-sale policy solutions.

Parent-child communication and marijuana initiation: evidence using discrete-time survival analysis.

This study supplements existing literature on the relationship between parent-child communication and adolescent drug use by exploring whether parental and/or adolescent recall of specific drug-related conversations differentially impact youth's likelihood of initiating marijuana use. Using discrete-time survival analysis, we estimated the hazard of marijuana initiation using a logit model to obtain an estimate of the relative risk of initiation. Our results suggest that parent-child communication about drug use is either not protective (no effect) or - in the case of youth reports of communication - potentially harmful (leading to increased likelihood of marijuana initiation).