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Aims To estimate the effect of potential regulations of electronic nicotine delivery systems (ENDS) among adult smokers, including increasing taxes, reducing flavour availability, and adding warning labels communicating various levels of risk. Design We performed a discrete choice experiment (DCE) among a national sample of 1,200 adult smokers. We examined heterogeneity in policy responses by age, cigarette quitting interest, and current ENDS use. Our experiment overlapped January, 2015 by design, providing exogenous variation in cigarette quitting interest from New Year resolutions. Setting KnowledgePanel, an online panel of recruited respondents. Participants 1,200 adult smokers from the United States. Measurements Hypothetical purchase choice of cigarettes, nicotine replacement therapy, and a disposable ENDS. Findings Increasing ENDS prices from $3 to $6 was associated with a 13.6 percentage point reduction in ENDS selection (p<0.001). Restricting flavour availability in ENDS to tobacco and menthol was associated with a 2.1 percentage point reduction in ENDS selection (p<0.001). The proposed FDA warning label was associated with a 1.1 percentage point reduction in ENDS selection (p<0.05), and the MarkTen warning label with a 5.1 percentage point reduction (p<0.001). We estimated an ENDS price elasticity of −1.8 (p<0.001) among adult smokers. Statistically significant interaction terms (p<0.001) imply that price responsiveness was higher among adult smokers 18–24 years of age, smokers who have vaped over the last month, and smokers with above the median quitting interest. Young adult smokers were 3.7 percentage points more likely to choose ENDS when multiple flavours were available than older adults (p<0.001). Young adult smokers and those with above the median cigarette quitting interest were also more likely to reduce cigarette selection and increase ENDS selection in January, 2015 (p<0.001), potentially in response to New Year’s resolutions to quit smoking. Conclusions Increased taxes, a proposed US Food and Drug Administration warning label for electronic nicotine delivery systems (ENDS) and a more severe warning label may discourage adult smokers from switching to ENDS. Reducing the availability of flavours may reduce ENDS use by young adult smokers.

We present guidance on electronic nicotine delivery systems (ENDS) for health care professionals who care for adolescents. ENDS provide users with inhaled nicotine in an aerosolized mist. Popular forms of ENDS include e-cigarettes and vape-pens. ENDS range in disposability, customization, and price. Growth of ENDS usage has been particularly rapid in the adolescent population, surpassing that of conventional cigarettes in 2014. Despite surging use throughout the United States, little is known about the health risks posed by ENDS, especially in the vulnerable adolescent population. These products may potentiate nicotine addiction in adolescents and have been found to contain potentially harmful chemicals. The growth in these products may be driven by relaxed purchasing restrictions for minors, lack of advertising regulations, and youth friendly flavors. Taken together, ENDS represent a new and growing health risk to the adolescent population, one that health care professionals should address with their patients. We suggest a patient centered strategy to incorporate ENDS use into routine substance counseling.

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