1. The Effect of Product Characteristics on Perceptions of E-cigarettes among Canadians Christine Czoli, PhD Student May 28, 2014

2. Background Source: Alderman L. (2013). E-Cigarettes are in vogue and at a crossroads. Retrieved from: http://www.nytimes.com/2013/06/13/business/e-cigarettes-are-in-vogue-and-at-a- crossroads.html?pagewanted=1&_r=0 http://www.nytimes.com/2013/06/13/business/e-cigarettes-are-in-vogue-and-at-a- crossroads.html?pagewanted=1&_r=0

3. Background Debate: public health benefit or harm? Limited research evidence

4. Background E-cigarette regulatory frameworks Targets for regulation?

5. Research Objective 1.To examine the relative importance of flavour, nicotine content, health warnings, and price among Canadians’: a) Perceptions of product taste b) Perceptions of product harm c) Perceptions of product efficacy in smoking cessation 2.To examine the extent to which outcomes a-d are moderated by smoking status, gender, and age.

6. Methods Study Design & Protocol Online survey + discrete choice experiment November 2013 1,188 Canadians, aged 16+

7. Methods Discrete Choice Experiment Random utility theory Tested 4 product attributes

8. Methods Product AttributesProduct Attribute Levels Flavour Tobacco Menthol Coffee Cherry

9. Methods Product AttributesProduct Attribute Levels Nicotine content None (0 mg) Low (6-8 mg) Medium(10-12 mg) High(16 mg)

10. Methods Product AttributesProduct Attribute Levels Health warning None “Health Canada has not approved this product for quitting smoking.” [HC] “This product is intended for use by existing smokers. It contains nicotine which is a highly addictive substance.” [EC1] “This product is intended for use by existing smokers aged 18 or over as an alternative to tobacco cigarettes. It contains nicotine which is a highly addictive substance. Consult your doctor if you are pregnant, breast feeding, allergic to nicotine or propylene glycol, or have high blood pressure.” [EC2]

11. Methods Product AttributesProduct Attribute Levels Price Low ($ 7.99) High ($ 9.99)

12. Methods Product AttributesProduct Attribute Levels Flavour Tobacco Menthol Coffee Cherry Nicotine content None Low Medium High Health warning None HC EC1 EC2 Price Low ($ 7.99) High ($ 9.99)

13. Methods Product AttributesProduct Attribute Levels Flavour Tobacco Menthol Coffee Cherry Nicotine content None Low Medium High Health warning None HC EC1 EC2 Price Low ($ 7.99) High ($ 9.99) $ 9.99

14. Methods Discrete Choice Experiment – Design Fractional factorial main effects design 16 pack profiles Arranged into 20 choice sets Each set containing 4 pack profiles + “none” Source: Kuhfeld, W. (2010). Marketing research methods in SAS.

15. Methods Choice Set #1 $ 9.99$ 7.99 None of the above

16. Methods Which one of these products do you think would taste better? $ 9.99$ 7.99 None of the above

17. Methods Which one of these products do you think would be less harmful? $ 9.99$ 7.99 None of the above

18. Methods Which one of these products do you think would help someone quit smoking? $ 9.99$ 7.99 None of the above

19. Methods Analyses Multinomial logit models 1. Attribute-level importance 2. Attribute importance

20. Results

21. Sample Characteristics (n = 1,188) Characteristic % (n) Age (years) Mean (SD) 32.8 (SD = 16.0) Gender Male42.4% (504) Female57.6% (684)

22. Perceptions of product taste Attribute-Level Importance Parameter EstimateSignificance Flavour Tobacco- 0.30p < 0.0001 Menthol- 0.16p < 0.0001 Coffee 0.02p = 0.1546 Cherry 0.44p < 0.0001 Nicotine content None- 0.02p = 0.2249 Low 0.10p < 0.0001 Medium- 0.02p < 0.0001 High- 0.07p < 0.0001 Health warning None 0.13p < 0.0001 HC- 0.24p < 0.0001 EC1- 0.05p = 0.0010 EC2 0.16p < 0.0001 Price Low 0.11p < 0.0001 High- 0.11p < 0.0001

23. Perceptions of product taste Attribute-Level Importance E-cigarettes with the following characteristics were perceived as better-tasting: Cherry flavour (p < 0.0001); Low nicotine (p < 0.0001); No health warning (p < 0.0001) and the EC2 health warning (p < 0.0001); Lower price (p < 0.0001)

24. Perceptions of product taste Attribute Importance Parameter Estimate Utility RangeRelative Importance Flavour Tobacco- 0.300.7448% Menthol- 0.16 Coffee 0.02 Cherry 0.44 Nicotine content None- 0.020.1711% Low 0.10 Medium- 0.02 High- 0.07 Health warning None 0.130.4026% HC- 0.24 EC1- 0.05 EC2 0.16 Price Low 0.110.2215% High- 0.11

25. Perceptions of product taste Attribute Importance Parameter Estimate Utility RangeRelative Importance Flavour Tobacco- 0.30 0.74 48% Menthol- 0.16 Coffee 0.02 Cherry 0.44 Nicotine content None- 0.02 0.17 11% Low 0.10 Medium- 0.02 High- 0.07 Health warning None 0.13 0.40 26% HC- 0.24 EC1- 0.05 EC2 0.16 Price Low 0.11 0.22 15% High- 0.11

26. Perceptions of product taste Attribute Importance

27. Perceptions of product harm Attribute-Level Importance E-cigarettes with the following characteristics were perceived as less harmful: Menthol (p < 0.0001) and coffee (p < 0.0001) flavours; Low nicotine (p < 0.0001); No health warning (p < 0.0001) and the EC2 health warning (p < 0.0001); Lower price (p < 0.0001)

28. Perceptions of product harm Attribute Importance

29. Perceptions of product quit efficacy Attribute-Level Importance E-cigarettes with the following characteristics were believed to help someone quit smoking: Menthol (p < 0.0001) and coffee (p < 0.0001) flavours; Low nicotine (p < 0.0001); No health warning (p < 0.0001) and the EC2 health warning (p < 0.0001); Lower price (p < 0.0001)

30. Perceptions of product quit efficacy Attribute Importance

31. Summary Health warnings were the most influential drivers of participants’ perceptions of product quit efficacy Flavour was the strongest predictor of perceptions of taste Flavour and health warnings significantly predicted perceptions of product harm

32. Strengths & Limitations Strengths DCE design Limitations Design did not include all attribute-level combinations Testing of a subset of attributes Use of a non-probability-based sample

33. Implications Regulatory Framework for E-cigarettes Potential targets for regulation Flavour and health warnings

34. Acknowledgements Research Team David Hammond, Maciej Goniewicz, Towhidul Islam, Kathy Kotnowski Funding Sources

35. Thank you Christine D Czoli, PhD Student School of Public Health & Health Systems cczoli@uwaterloo.ca

36. Perceptions of product taste Pack Utility Parameter Estimate Flavour Tobacco- 0.30 Menthol- 0.16 Coffee 0.02 Cherry 0.44 Nicotine content None- 0.02 Low 0.10 Medium- 0.02 High- 0.07 Health warning None 0.13 HC- 0.24 EC1- 0.05 EC2 0.16 Price Low 0.11 High- 0.11 Which one of these products do you think would taste better? $ 9.99 Utility = 0.38

37. Perceptions of product taste Pack Utility

38. Perceptions of product taste Pack Utility

39. Perceptions of product taste Pack Utility

40. Perceptions of product harm Pack Utility

41. Perceptions of product harm Pack Utility

42. Perceptions of product harm Pack Utility

43. Perceptions of product quit efficacy Pack Utility

44. Perceptions of product quit efficacy Pack Utility