A best–worst scaling survey of adolescents' level of concern for health and non-health consequences of smoking

This paper uses best–worst scaling, a choice-based survey method, to assess adolescents' level of concern for various adverse consequences of tobacco use. In addition to health risks cited most often (i.e., lung cancer and cardiovascular diseases), the study also focuses on less frequently mentioned health implications (e.g., effects on teeth, appearance, skin, weight and sexual dysfunction) and other adverse effects that are unrelated to health, such as cost, addiction, or manipulation by the tobacco industry. The relative importance of 15 items was assessed in a sample of 376 adolescents (ages 14–19 years) in Western Switzerland. The resulting data provide rich information on the relative importance of the items considered and even allow for the assessment of individual-level preference scales. The results indicate that apart from lung cancer that is consistently rated as being of most concern, less-mentioned health risks such as reduced physical capacity and sexual dysfunction are of significant importance. Subgroup analyses and results from a random parameter approach highlight substantial heterogeneity in preferences that should be exploited in future prevention messages.