The Economics of Electronic Nicotine Delivery Systems: Advertising and Outcomes

 描述（由申请人提供）：电子尼古丁输送系统（ENDS），其中电子烟构成最常见的子产品，是吸烟的不可燃替代品。ENDS最近才被引入美国市场，并得到大力推广，在成年人和青少年中的使用正在迅速增加。2013年，15%的成年人报告使用过电子烟，而四年前这一比例仅为0.6%。2012年，近178万初中和高中生报告使用该药物，其流行率是一年前的两倍多。与此同时，广告在2010年至2013年期间增长了近15倍，2011年至2013年期间，年轻人接触电视广告的比例上升了256%。人们对使用ENDS的长期健康影响以及ENDS的使用如何影响吸烟知之甚少。监管辩论的核心是关于ENDS是否会吸引吸烟者远离危险的习惯或引诱新的吸烟者使用烟草并导致新一代尼古丁成瘾者的基本问题。FDA和2014年卫生部长报告承认这场辩论的双方，但强调需要科学证据来告知这些问题。尽管来自29个州的总检察长呼吁更严格的营销限制， FDA在最近的裁决中没有包括任何此类限制。关于ENDS广告和其他政策对ENDS和烟草使用模式的影响，没有严格的证据基础。我们将通过对杂志和电视上的ENDS广告（占媒体广告支出的近90%），在线横幅广告和社交媒体上的ENDS广告影响成人和青少年使用ENDS模式的程度进行首次全面分析，以及ENDS使用和吸烟行为之间的过渡，包括吸烟者的开始，停止和复吸。此外，该项目还将提供一些初步估计，以告知州烟草控制项目管理人员确定的与其他政策因素有关的关键知识差距，如无烟立法，对可用性和使用的限制，以及烟草税和ENDS。我们将进一步探讨广告和政策反应的异质性，这些异质性跨越相关边缘（启动与停止;密集与广泛），跨越青年和成年人，以及各种其他社会人口因素。这些问题将使用六个大规模的国家个人层面数据集进行评估，每个数据集都有不同的优势，其中许多数据集具有纵向或回顾性信息，并与广告曝光和烟草控制政策矢量的独特和详细信息相匹配。拟议的研究对于了解ENDS的公共健康影响至关重要，并将提供所需的证据来支持FDA对营销的监管决定，并指导州政策制定者制定法规。

 DESCRIPTION (provided by applicant): Electronic Nicotine Delivery Systems (ENDS), of which e-cigarettes constitute the most common sub- product, are a non-combustible alternative to smoking. Only recently introduced into the US market, ENDS have been aggressively promoted, and use is increasing rapidly among both adults and youths. In 2013, 15% of adults reported having used e-cigarettes, compared with 0.6% just four years ago. Almost 1.78 million middle- and high-school students reported use in 2012, more than double the prevalence from just one year ago. Concurrently, advertising grew almost 15-fold between 2010-2013, with youth exposure to TV ads rising 256% between 2011 and 2013. Very little is known about the long-term health effects of using ENDS, and how ENDS use affects smoking. At the heart of the regulatory debate are fundamental questions regarding whether ENDS will draw cigarette smokers away from a dangerous habit or lure new initiates into tobacco use and lead to a new generation of nicotine addicts. The FDA and the 2014 Surgeon General's Report acknowledge both sides of this debate, but underscore the need for scientific evidence to inform these questions. Despite calls from attorneys general from 29 states for stricter marketing restrictions, the FDA refrained from including any such restrictions in its recent ruling. There is no rigorous evidence base on the impact of ENDS advertising and other policies on patterns of ENDS and tobacco use. We will address this knowledge gap by undertaking the first comprehensive analyses of the extent to which advertising of ENDS in magazines and on TV (constituting almost 90% of media ad spending), online as banner ads, and in social media impacts patterns of ENDS use among both adults and youths, as well as transitions between ENDS use and smoking behaviors, including initiation, cessation, and relapse among formers smokers. Furthermore, the project will also provide some of the first estimates to inform key knowledge gaps identified by state tobacco control program managers relating to other policy factors such as smoke-free legislation, restrictions on availability and use, and tobacco taxes and ENDS. We will further explore heterogeneity in the advertising and policy responses across relevant margins (initiation vs. cessation; intensive vs. extensive), across youths and adults, and across various other socio-demographic factors. These questions will be assessed using six large- scale national individual-level datasets, each with distinct strengths and many of them with longitudinal or retrospective information, matched with unique and detailed information on advertising exposure and a vector of tobacco control policies. The proposed research is essential for understanding the public health impact of ENDS and will provide the needed evidence to support the FDA's regulatory decisions over marketing as well as guide state policy-makers in their regulations.