Unintended consequences

A new study from Duke Health, to be published in Substance Use & Misuse, found that efforts by the U.S. Food and Drug Administration (FDA) and some cities to limit the availability and appeal of e-cigarettes to young users could drive some existing users to smoke more tobacco cigarettes to get their fix.

The online survey asked participants aged 18 to 29 to predict their use of two products—e-cigarettes and traditional tobacco cigarettes, which they already used—in response to hypothetical regulations to limit e-cigarette flavors, limit the customization of e-cigarettes or eliminate the nicotine in e-cigarettes.

Of the respondents, 47 percent said if regulations eliminated the nicotine in e-cigarettes, they wouldn’t use e-cigarettes as much and would increase their use of traditional cigarettes.

If regulations limited the customization of devices, such as features allowing users to adjust nicotine dose or vapor temperature, 22 percent said they would use e-cigarettes less frequently and smoke more tobacco cigarettes.

If e-cigarettes were to be limited to tobacco and menthol flavors, 17 percent said they wouldn’t use e-cigarettes as much and would smoke more tobacco cigarettes.

“It’s likely some potential new regulations on e-cigarettes will result in a net good for the whole population, such as limiting flavors that might entice young users, improving safety standards or mandating that liquids come in childproof containers,” said Lauren Pacek, the study’s lead author.

“However, our findings suggest that there should also be thoughtful consideration to potential unintended consequences that could affect other subsets of users of e-cigarettes and other tobacco products.”