A new international study reveals that adults who use disposable and non-disposable e-cigarettes differ in meaningful ways, and that those differences vary between countries. Comparing users in the United States and Israel, researchers found that flavor preferences, perceptions of harm, and purchasing habits strongly influence device choice. The findings suggest that effective e-cigarette regulation must be tailored to local patterns of use rather than relying on a single global approach.

Disposable e-cigarettes have exploded in popularity worldwide, but not all users are alike, and that matters for public health. A new international study led by International MPH student, Dr. Beghashaw Mulu, under the supervision of Prof. Yael Bar-Zeev of the Braun School of Public Health and Community Medicine at the Hebrew University of Jerusalem sheds light on who uses disposable versus reusable e-cigarettes in the United States and Israel, and what drives those choices.

Drawing on survey data from more than 400 adults aged 18 to 45 who currently use e-cigarettes, the researchers found clear and striking differences between disposable and non-disposable users, with important variations between countries. In Israel, adults who viewed e-cigarettes as more harmful were actually more likely to use disposable devices, particularly when buying them in convenience stores and kiosks. In the United States, disposable use was strongly linked to a preference for sweet flavors and prior use of other tobacco or nicotine products.

One finding stood out across both countries. Users of refillable, non-disposable devices were far more likely to vape cannabis or cannabinoid-containing liquids. This raises concerns about regulatory blind spots, especially as non-disposable devices allow greater customization and are harder to monitor.

“Disposable e-cigarettes are often discussed as a single category, but our findings show that who uses them, and why, depends heavily on local context,” says Prof. Yael Bar-Zeev, the study’s lead author. “Policies that work in one country may miss the mark in another if they do not account for these differences.”

The study arrives as several countries debate or implement bans on disposable e-cigarettes, driven by concerns over youth use, nicotine addiction, and environmental waste. While such bans may reduce access to sweet, highly appealing products, particularly in the United States, the researchers caution that unintended consequences are possible if regulations fail to address non-disposable devices and their use for cannabis consumption.

“Our results suggest that focusing only on disposables could leave significant risks untouched,” Prof. Bar-Zeev explains. “Effective regulation needs to be nuanced, protecting young people and public health while recognizing how adults actually use these products in real life.”

By comparing two countries with very different regulatory environments, the study highlights a simple but powerful message. When it comes to vaping policy, one size does not fit all.