E-cigarettes' customizability is a big part of their appeal, particularly to young adults. Not only do the liquids for e-cigarettes come in a wide variety of flavors, their nicotine content, wattage and air flow can all be customized. The ability to personalize one's e-cigarette can encourage people to start vaping and continue to vape, even in addition to traditional cigarettes.

Young adults are particularly vulnerable to developing a smoking habit that includes both traditional and e-cigarettes. So researchers at Duke Health wanted to look at how hypothetical regulations to limit the more appealing characteristics of e-cigarettes would affect e-cigarette and traditional cigarette use among 18- to 29-year-olds.

The bad news was they found these regulations might actually increase young adults’ use of traditional cigarettes. The findings were not a surprise, but they were concerned by the predicted increases in traditional cigarette use.

About half of the respondents said they would increase their traditional cigarette use and decrease their e-cigarette use if regulations eliminated the nicotine in e-cigarettes.

“It is an outcome you want to avoid, and points to the need for regulations to be put in place in a thoughtful and careful way,” lead author, Lauren Pacek, told TheDoctor.

Nearly 250 young men and women were asked in an online survey to predict their e- and traditional cigarette use in response to hypothetical regulations to limit the availability of e-cigarette flavors, limit the customizability of e-cigarettes and eliminate the nicotine in e-cigarettes.

Almost 47 percent of the respondents said they would increase their traditional cigarette use and decrease their e-cigarette use if regulations eliminated the nicotine in e-cigarettes. Twenty-two percent said if regulations limited the customizability of e-cigarettes, such as the ability to adjust the nicotine dose or the vapor temperature, they would increase traditional cigarette use and decrease e-cigarette use. And nearly 17 percent of respondents said they would increase traditional cigarette use and decrease e-cigarette use if regulations limited available e-cigarette flavors to menthol and tobacco.

The study was small and not designed to predict behavior among all e-cigarette users in the U.S., and Pacek and co-author Joseph McClernon, a professor of psychiatry and behavioral sciences at Duke, recently received funding to test users’ responses to some of these hypothetical e-cigarette regulations in a laboratory setting. They plan to bring people into their lab for several visits to assess the effect of being able to choose an e-cigarette flavor on subsequent use of traditional cigarettes.

In 2016, the FDA expanded their regulatory authority to cover the manufacturing, marketing and distribution of all tobacco products, including e-cigarettes. Some additional regulation is likely to happen, and is probably necessary, Pacek, an assistant professor of psychiatry and behavioral sciences at Duke, believes. “But our findings suggest consideration be given to the unintended consequences of these regulations for certain users of tobacco products, such as young people.”

The study was published recently in Substance Use & Misuse.