Smokers’ Decision-Making about Tobacco Use: The Interplay of Affective and Cognitive Factors with Product Characteristics

项目摘要 可燃烟草制品，主要是香烟，是美国癌症的最大单一原因。 所有烟草产品的增长将对美国癌症发病率产生无可争议的巨大影响;然而，模拟模型 这表明，如果成年吸烟者改用电子尼古丁， 作为可燃烟草产品的完全替代品。研究已经确定 关于ENDS的健康风险和益处的不确定性和误解，以及消费者 对产品特性的不满意，限制引发和完全替代可燃香烟。 该项目的目标是解决及时评估价格、室内空气质量和环境质量的关键需求。 政策和ENDS产品特征（产品类型和设计，口味，减少吸烟渴望的能力） 与风险/效益观念相互作用，影响吸烟者拒绝产品的决定， 几支香烟，完全转向这些产品，或使用ENDS完全戒烟 产品.在概念框架的指导下，目标1将涉及120名定性焦点小组访谈 目前/以前的成年吸烟者，并在1年内进行强化评估（12周一次，然后3个季度一次）， 最近开始使用ENDS的当前吸烟者检查ENDS产品特性如何影响 吸烟者决定开始使用可燃烟草产品、与可燃烟草产品两用或替代可燃烟草产品。在 深入的纵向研究，分段，动态的潜在类分析将测试有关影响的假设 产品特性的影响以及情境因素、认知和情感决策的动态相互作用 烟草使用的过程、烟草使用以及形成烟草使用模式和轨迹的经验。在目标2中， 将进行行为实验和随机临床试验。离散选择实验（discrete choice experiment，DCE） 在对300名目前吸烟者进行的深入纵向研究的基线调查中， ENDS产品特征对风险/受益感知的相对重要性;产品偏好，以及 使用意图，并评估这些偏好对未来烟草使用和模式的预测有效性。 第二次DCE将检查产品特征、风险/受益感知和背景 因素（例如，产品是否可在禁止吸烟的地方使用），以决定吸烟者对产品的喜好 2400名成年吸烟者的全国代表性样本，他们目前，以前或从未使用过 ENDS/Heat-not-Burn（HnB）产品。这些结果将为创新的实验操作提供信息。 假设购买任务（HPT）范式与全国代表性样本的1800名成年吸烟者 根据他们之前的ENDS/HnB经验进行分层。这项随机临床试验将操纵风险/获益 对ENDS/HnB产品的看法，以估计对吸烟者消费（需求）的影响 香烟、ENDS和HnB，包括ENDS和HnB彼此的可替代性或互补性 以及控制决策偏差、感知成瘾和环境因素的可燃香烟。

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.