Restricting choice of e-cigarette flavor and device type increases choices to use combusted cigarettes among adults who dual use both products: Results from a within-subjects randomized trial.

INTRODUCTION: Data from real-world e-cigarette (EC) flavor bans suggest that such bans may increase combusted cigarette (CC) use. However, experimental data are needed to better understand how EC characteristics affect EC appeal and CC use. METHODS: Participants were adults who used both CC and flavored EC. They made 10 choices per session between taking two puffs from an EC or CC (supplied by study) or abstaining. EC type was unblinded and varied across three counterbalanced sessions: 1) own device and flavor, 2) study device with a non-tobacco-flavored e-liquid, and 3) study device with a tobacco-flavored e-liquid. Analyses evaluated EC appeal and choices to use EC, CC, or abstain. RESULTS: Participants (n = 41) reported using CCs on 22.1 days/month and ECs on 26.9 days/month. Appeal of study EC was lower than participants' own EC, and participants made fewer choices for EC during tobacco-flavor EC versus own device sessions (p = 0.006). Relative to own device sessions, participants made a greater number of choices for CC when study EC were available (p's < 0.05), regardless of flavor. DISCUSSION: Regulators and public health officials should be aware that restricting EC characteristics such as device type and flavor may increase consumption of CC among people who use both products, especially people who find restricted EC less appealing than their own device. Findings are consistent with real-world sales data following EC flavor bans.

Duke Scholars

Author F Joseph McClernon Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...