Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment

<jats:sec><jats:title>Objectives</jats:title><jats:p>To provide the policy-relevant estimates of impacts of alternative flavour bans on preferences and demand for cigarettes and e-cigarettes in adult smokers and recent quitters.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A best–best discrete choice experiment (DCE) is used to elicit smokers’ and recent quitters’ preferences for flavours, price, health impact and nicotine level in cigarettes and e-cigarettes. Choice of tobacco products and an opt-out option were examined. An efficient design yielded 36 choice sets. Exploded logit choice models were estimated. Flavour bans are modelled by restricting flavour coefficients in the estimated model.</jats:p></jats:sec><jats:sec><jats:title>Setting and participants</jats:title><jats:p>A sample of 2031 adult smokers and recent quitters was recruited to complete an online survey and DCE.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Current smokers and recent quitters, on average, prefer cigarettes and menthol cigarettes over flavoured e-cigarettes. However, there is substantial preference heterogeneity by younger adults (ages 18–25), race/ethnicity and respondents with higher education. Our predictions suggest that a ban on menthol cigarettes would produce the greatest reduction in the choice of cigarettes (−5.2%), but with an accompanying increase in e-cigarettes use (3.8%). In contrast, banning flavours in e-cigarettes, while allowing menthol in cigarettes would result in the greatest increase in the selection of cigarettes (8.3%), and a decline in the use of e-cigarettes (−11.1%). A ban on all flavours, but tobacco in both products would increase ‘opting-out’ the most (5.2%) but would also increase choice of cigarettes (2.7%) and decrease choice of e-cigarettes (−7.9%).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>A ban on flavoured e-cigarettes alone would likely increase the choice of cigarettes in smokers, arguably the more harmful way of obtaining nicotine, whereas a ban on menthol cigarettes alone would likely be more effective in reducing the choice of cigarettes. A ban on all flavours in both products would likely reduce the smoking/vaping rates, but the use of cigarettes would be higher than in the status quo. Policy-makers should use these results to guide the choice of flavour bans in light of their stance on the potential health impacts both products.</jats:p></jats:sec>