Association for Public Policy Analysis & Management

Research Objective: While United States adult smoking prevalence stagnates, electronic cigarettes (ECs) gain popularity. ECs are currently unregulated at the federal level. In April 2014, the US Food and Drug Administration’s (FDA) Center on Tobacco Products proposed that ECs be subject to FDA regulation. The FDA’s proposal, among other things, highlighted interest in evidence to inform the regulation of EC liquid flavors and requiring approval for modified risk descriptors suggesting lower harm potential. Evidence is needed to inform the FDA regulation of EC liquid flavors and modified risk descriptors suggesting lower harm potential.

Study Design: Two studies examine how abuse liability, a measure of consumers’ potential to abuse a product, varies by EC liquid flavors and the presence of modified risk messages and compared to own brand combustible tobacco cigarettes (OB CTC). Using two within-subjects designs we assessed abuse liability across EC liquid flavor (tobacco vs. menthol; unflavored vs. cherry) and message (reduced harm vs. no message; reduced exposure to carcinogens vs. no message) conditions. At baseline, own brand CTC abuse liability was assessed, and participants sampled EC flavors. Abuse liability was measured using a revealed preference method, the multiple-choice procedure (MCP), which randomly reinforces participants’ choices of preference for puffs or money.  In each condition, participants completed five MCP trials. Linear regressions compare the crossover points at which participants chose money over EC or OB puffs after adjusting for OB CTC flavor preference (menthol, tobacco). Standard errors were adjusted for repeated measures.

Population Studied: We sampled regular CTC smokers naïve to ECs. We accrued 28 subjects across both studies for a total of 230 observations across all studies, policy conditions, and MCP trials. Our sample is predominantly African American, female, smokes menthol OB CTC, and on average is 46 years old.

Principal Findings: After adjustment, in the first study (tobacco vs. menthol; reduced harm vs. no message), the crossover point for OB CTC was $1.89. For all EC conditions, crossover points were significantly lower than OB CTC: these ranged from -$0.71 (95% CI -$1.31, -$0.10; tobacco flavor/reduced harm message) to -$0.81 (95% CI -$1.48, -$0.13; menthol flavor/no message). In the second study (unflavored vs. cherry; reduced exposure to carcinogens vs. no message), similar significant patterns of effects in crossover points were observed, although the magnitudes were larger. Importantly, modified risk messages were positively associated with abuse liability.

Conclusions: This study provides preliminary evidence that flavor availability and modified risk messages associated with ECs may increase current combustible cigarette smokers’ potential to abuse ECs.  

Implications for Policy or Practice: If confirmed with continued data collection and research, the results suggest how FDA regulations on EC flavors and modified risk messages may affect CTC smokers’ uptake and use of EC products.