Table.

Factors in the Viability of Approaches to Reducing Youth Use of Electronic Nicotine Delivery Systems

Approach	Advantages/Opportunities	Disadvantages/Limitations

Limiting flavored ENDS	Flavors are a key reason for youth ENDS use Youth prefer sweet flavors more than adults	Adults are also attracted to flavors May inhibit adult smokers from switching from smoking to exclusive ENDS use
Reducing the high-tech appearance of ENDS	High-tech appearance of ENDS fits squarely into youth and young adult technology culture	May also limit appeal among adult smokers who might benefit from potentially reduced-risk products
Raising taxes or discontinuing use of coupons and price incentives for ENDS	Youth are more responsive to price than adults	Could reduce ENDS use among adult smokers, particularly those with low income Could discourage a complete switch from smoking to ENDS if price of combusted products is not also increased
Limiting minimum age of sales or purchase of ENDS to adult-only facilities	Could reduce retail sales as an avenue for youth acquisition	Some adult-only facilities have a higher violation rate than non-adult-only facilities Most ENDS obtained by youth are from social sources Limiting to adult-only facilities would reduce access locations for adult smokers
Incorporating biometrics into ENDS	Would largely eliminate social sources as means of obtaining ENDS by youth	Would complicate internet and retail sales for adults Could increase the cost of ENDS, and reduce its uptake among adult smokers, particularly those with low income May encourage more consumer-made devices Could also allow tobacco companies to obtain private information about user behaviors
Ban indoor use of ENDS	Would reduce misperceptions about indoor bans on smoking Would reduce secondhand aerosol exposure	Discreteness of ENDS may make it difficult to enforce
Reducing discreteness	Discreteness is more critical for youth use	Would reduce adult stealth vaping, which could deter ENDS use among adult smokers
Incorporating geofencing	Could be targeted to schools or other locations where youth gather	May be used to track users for marketing purposes
Limiting nicotine delivery	Could minimize likelihood of youth appeal or addiction	May inhibit adult smokers from switching from smoking to exclusive ENDS use Multiple characteristics must be addressed (e.g., pH and product design features) Would only allow authorization of closed systems

ENDS – Electronic nicotine delivery systems, e.g., e-cigarettes.