Novel smokeless tobacco products modeled on pasteurized Swedish snus, which is very low in tobacco-specific nitrosamines and appears to have low health risks, are now available in the US market. These products have been marketed by manufacturers, including Philip Morris and RJ Reynolds, and differ from the snuff and chew products traditionally sold and used domestically. Most of these products are marketed to smokers for situations when they are unable to smoke (e.g., public indoor areas). Dual use of smokeless tobacco (ST) and cigarettes is a growing concern, but relatively little is known about smokers'interest in using smokeless products as a temporary substitute for cigarette smoking or willingness to switch over completely from cigarettes to ST. A decision to radically change mode of nicotine delivery may depend at least in part on price, especially price relative to cigarettes-a substitute product offered at a discount may be viewed as more or less attractive, for example. The proposed series of studies attempts to address these questions using complementary approaches that address different aspects of the relationship of price to product adoption, considering other mediating and moderating factors. The first study will use a web-based purchase task to examine the demand curve for ST and cigarettes using behavioral economic methods. Current smokers (n=1008) will be randomly assigned to view or not view product advertisements before completing the purchase tasks, to examine the effect of marketing on characteristics of the demand curve. Cross-price elasticity will also be assessed by jointly presenting both classes of products, with the substitute offered at a fixed price ($1). A second set of studies using experimental auction methods commonly used by economists will be employed to gain insight into the relative value of ST and cigarettes by determining smokers'willingness to pay under different scenarios. Rather than a simulation (as in Aim 1), this involves the actual purchase of real products, and so may serve as a more accurate indicator of interest in a given product. A total of 675 smokers will take part in auctions. The auctions will feature a manipulation of the type and tone of information presented to participants about the products for bid. Another group of participants will be offered the opportunity try the product (Camel Snus, Ariva, Commit) prior to bidding (an attempt to mimic 'free sampling'). The final component of this research project is to examine the influence of price, availability, and information on substitution of ST for cigarettes in a population of current smokers. Participants (N=240) will be randomly assigned to one of 6 cigarette price conditions, with ST products (Camel Snus, General Snus, Ariva) offered at a fixed price, and will participate in weekly 'purchases'of tobacco products in a simulated retail environment. An extensive baseline questionnaire will provide information on potential mediating (estimated elasticity of demand) and moderating (delay discounting, nicotine dependence, demographics) variables. Availability of various ST products and cigarettes will be manipulated at different study sessions, as will the availability of information about ST products. We plan to examine the influence of price, availability, and information on the degree of observed substitution of ST products for cigarettes. Outcome measures include cigarettes and ST units consumed per day, saliva cotinine levels, alveolar CO levels, and indicators of nicotine dependence, craving, and withdrawal. The set of studies may help to tease apart the various aspects of the price-product relationship and so better inform public policy debates.
Novel smokeless tobacco products are now available in the US market, targeted toward smokers, and appearing to have lower health risks compared to cigarettes. However, concerns remain that adoption of these products could harm public health by preventing quitting and attracting new users. As more ST products are introduced, and smokers look for alternatives to cigarettes, how will the market develop? A decision to radically change mode of nicotine delivery may depend at least in part on price (both monetary and otherwise), especially price relative to cigarettes. The proposed series of studies attempts to address these questions using complementary approaches that address different aspects of the relationship of price to product adoption, considering other mediating and moderating factors.
