Factors associated with using disposable versus non-disposable electronic cigarettes among adults in the U.S. and Israel: a cross-sectional study with policy implications

Background: In recent years, there has been a rapid increase in disposable electronic cigarette (e-cigarette) use. Several countries have banned or are considering banning disposable e-cigarettes, which might affect adults who use disposable e-cigarettes for harm reduction. Understanding patterns of disposable versus non-disposable e-cigarette use among adults who currently use e-cigarettes is essential to inform possible regulations and policy. This study explored factors associated with disposable versus non-disposable e-cigarette use among adults currently using e-cigarettes in the U.S. and Israel. Method: A cross-sectional online survey was conducted (October-December 2021) among 410 U.S. and Israeli adults aged 18–45 years (mean age 30.8 ± 7.6) who reported past 30-day e-cigarette use (62.9% of whom used non-disposables). A multivariate logistic regression assessed factors associated with disposable versus non-disposable e-cigarette use, stratified by country. Result: In Israel, a greater perceived harm of e-cigarettes (aOR = 1.45, 95%CI: 1.20–1.76), cannabis/cannabinoid-containing e-liquid use (aOR 0.36, 95%CI: 0.19–0.69) and purchasing from ‘regular’ shops (aOR = 6.30, 95%CI: 2.25–17.67) or ‘specialty’ shops (aOR = 3.71, 95%CI: 1.21–11.34) (compared to ‘online’ shops) were associated with disposable e-cigarette use. In the U.S., factors associated with disposable e-cigarette use included ever using other tobacco/nicotine products (aOR = 7.51, 95%CI: 1.49–37.87), sweet flavor preference (aOR = 4.42, 95%CI: 1.64–11.94), cannabis/cannabinoid-containing e-liquid use (aOR = 0.33, 95% CI: 0.13–0.82), and being 26–35 years old (vs. 36–45) (aOR = 0.36, 95% CI: 0.13–0.98). Conclusions: U.S. and Israeli adults who use disposable versus non-disposable e-cigarettes differ, highlighting the importance of public health strategies tailored to the unique needs of each country. The high levels of cannabis or cannabinoid-containing e-liquid use among participants who use non-disposable e-cigarettes suggest the need for stricter regulation and enforcement of non-disposable devices and e-liquids in both countries. Findings also suggest that banning sweet flavored e-cigarettes will support the effort in reduction of disposable e-cigarette use in the U.S.