Informing E-cigarette Policy: Population Effects and Tobacco Industry Incentives Open Access

Cahn, Zachary Phillip (2016)

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This dissertation consists of a set of papers intended to inform practitioners and scholars of nicotine policy in general and e-cigarettes specifically. The first chapter frames the subsequent chapters and introduces some key concepts that are necessary to understand this framing. The second chapter synthesizes the research on past obstacles to cigarette innovation in order to 1) determine why cigarette innovation did not yield substantially reduced hazard for decades, and 2) gain insight into how tobacco companies are likely to behave today and in the future. Special attention will be paid to the emergence of e-cigarettes and why the industry did not enter this market sooner. The third chapter focuses on the potential for e-cigarettes to "renormalize" cigarette smoking. Looking at one specific pathway - social renormalization - this chapter seeks to estimate whether peer vaping affects the perception of peer smoking among youths. The fourth chapter examines predictors of initiation of e-cigarette use among consistent smokers and analyzes the impact of e-cigarette use on cessation among smokers in a national U.S. consumer panel. The fifth chapter puts the findings from the previous chapters into context and develops core lessons for scholars that seek to study e-cigarettes and policymakers that seek to regulate them.

Table of Contents

Distribution Agreement. i

Approval Sheet. ii

Abstract. iv

Acknowledgements. vi

Tables and Figures. ix

Chapter 1. Approaching e-cigarette policy: Harm reduction and population effects. 1

Introduction. 1

Dynamic Harm Reduction. 1

Static Harm Reduction. 3

Policymaking Amidst Uncertainty. 9

References. 11

Chapter 2. Barriers to hazard-reducing innovation: Understanding why e-cigarettes did not emerge sooner. 13

Introduction. 13

Incentives, Disincentives, and Innovative Effort. 14

Indirect Disincentives: Threats to the Existing Business. 15

Direct Disincentives: Substance and Substantiation. 21

Perceived Feasibility: Do the Scientists Foresee Success?. 24

Bottom-up Disincentives. 25

Modifying Factors. 29

Discussion. 31

Conclusions. 32

References. 33

Tables and Figures. 39

Chapter 3. Assessing "Renormalization" of smoking: How does peer e-cigarette use affect perceived peer smoking rates?. 43

Introduction. 43

Methods. 45

Analytic Strategy. 48

Results. 49

Discussion. 51

Strengths and Limitations. 52

viii Conclusions. 53

References. 53

Chapter 4. Characteristics of smokers purchasing e-cigarettes and the association with cessation: An examination using a national USA consumer panel. 60

Introduction. 60

Methods. 63

Results. 66

Discussion. 68

Limitations. 70

Conclusions. 71

References. 71

Chapter 5. Lessons for E-cigarette Research and Policy. 82

Lessons for Researchers. 82

Lessons for Policymakers. 88

Prudent Policymaking Under Uncertainty. 92

References. 98

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