||5R01CA235719-02 Interpret this number
||Georgia State University
||Smokers’ Decision-Making About Tobacco Use: the Interplay of Affective and Cognitive Factors with Product Characteristics
PROJECT SUMMARY ABSTRACT
Combustible tobacco products, primarily cigarettes, are the single greatest cause of cancer in the U.S. Cessation
of all tobacco products would have an indisputably large impact on U.S. cancer rates; however, simulation models
indicate that a significant benefit over the next two decades will occur if adult smokers switch to electronic nicotine
delivery systems (ENDS) as a complete substitute for combustible tobacco products. Research has identified
that uncertainty and misperceptions about the health risks and benefits of ENDS, as well as consumer
dissatisfaction with product characteristics, limit initiation and complete substitution for combustible cigarettes.
The objective of this project is to address the critical need for timely evidence evaluating how price, indoor-air
policies, and ENDS product characteristics (product type and design, flavors, ability to reduce cravings to smoke)
interact with risk/benefit perceptions to affect smokers’ decisions to reject the products, to substitute them for only
a few cigarettes, to switch exclusively to these products, or to use ENDS to completely quit using tobacco
products. Guided by a conceptual framework, Aim 1 will involve qualitative focus-group interviews of 120
current/former adult smokers, and an intensive assessment over 1 year (12 weekly, then 3 quarterly) with 300
current smokers who recently initiated ENDS use to examine how ENDS product characteristics influence
smokers’ decisions to initiate, dual use with, or substitute for their use of combustible tobacco products. In the
intensive longitudinal study, a piecewise, dynamic latent class analysis will test hypotheses regarding the effects
of product characteristics and the dynamic interplay of contextual factors, cognitive and affective decision-making
processes, tobacco use, and experiences in shaping patterns and trajectories of tobacco use. In Aim 2, two
behavioral experiments and a randomized clinical trial will be conducted. A discrete-choice experiment (DCE) will
be embedded in the baseline survey of the intensive longitudinal study of 300 current smokers to examine the
relative importance of ENDS product characteristics on risk/benefit perceptions; product preferences, and
intentions for use, and evaluate the predictive validity of these preferences on future tobacco use and patterns.
A second DCE will examine the interaction of product characteristics, risk/benefit perceptions, and contextual
factors (e.g., whether products can be used where smoking is prohibited) on smokers’ preferences for the product
with a nationally representative sample of 2400 adult current smokers who currently, formerly, or never used
ENDS/Heat-not-Burn(HnB) products. These results will inform the experimental manipulations in an innovative
hypothetical purchase task (HPT) paradigm with a nationally representative sample of 1800 adult smokers
stratified by their prior experience with ENDS/HnB. This randomized clinical trial will manipulate risk/benefit
perceptions of ENDS/HnB products to estimate the effect on smokers’ consumption (demand) of conventional
cigarettes, ENDS, and HnB, including the substitutability or complementarity of ENDS and HnB for each other
and for combustible cigarettes controlling for decision-making biases, perceived addiction, and contextual factors.
What Motivates Smokers to Switch to ENDS? A Qualitative Study of Perceptions and Use.
, Henderson K.C.
, Geier A.
, Weaver S.R.
, Spears C.A.
, Ashley D.L.
, Fritz M.
, John L.
, Pechacek T.F.
International journal of environmental research and public health, 2020-11-28; 17(23), .