The United States (U.S.) Food and Drug Administration has expressed concern about flavored e-cigarettes (e.g., JUUL brand) because they are appealing to youth who may be unaware that the product is addictive. The Population Assessment of Tobacco and Health Study Wave 3 provided data on flavor categories, type of e-cigarette product, and smoking status among past 30-day youth and adult e-cigarette users in the US. Most past 30-day youth and adult users reported using only one flavor category, with fruit (53% youth, 31% adult) being the most commonly reported category. Adults were far more likely to report using tobacco flavor alone, compared to any other individual flavor category or flavor category combinations (OR: 21.08, 95%CI: 5.92, 75.12). Whereas, youth were more likely to report using multiple flavor categories (OR: 2.03, 95%CI: 1.55, 2.65), with the most reported pairing being fruit and candy (36%). The variety of flavors on the market appeals to consumers of all ages. Although most past 30-day e-cigarette users reported only one flavor category, non-tobacco flavors were far more common among youth. Differences in flavor preferences among adult versus youth vapers may have implications for the role of flavors in both the initiation of youth vaping and adult vaping for smoking cessation.
IntroductionFlavored e-cigarettes are enticing to new users and established cigarette smokers using e-cigarettes to quit smoking due to the wide variety of flavor options. However, specific flavor combinations that are popular among e-cigarette users are understudied. Recently, the Deeming rule extended the US Food and Drug Administration’s authority over all tobacco products, including e-cigarettes.MethodsThe Population Assessment of Tobacco and Health Study Wave 2 data were analyzed to assess the prevalence of self-reported flavor categories that are used individually and in combination with other flavor categories among past 30-day youth and adult e-cigarette users in the US.ResultsMost youth and adult participants reported using a flavored e-cigarette. Reporting an individual flavor category was more common than reporting a combination of flavor categories. Fruit flavor was the most common flavor category reported among youth, and ‘menthol/mint’ was most common among adults. Fruit and candy/other sweets were the most common flavor categories reported together among both youth and adult past 30-day e-cigarette users.ConclusionsThe use of flavored e-cigarettes is very popular among youth and adults. Most consumers reported using a single flavor category, although some consumers did use a combination of flavor categories. Preference for menthol/mint among adults may represent a carryover from associations with tobacco cigarettes. Typically, sweeter flavors, such as fruit, were among the most popular flavor categories reported, both individually and in combination with other flavors, while more bitter flavors (i.e.: clove/spice) were less common.ImplicationsThis study identified predominant flavor categories among past 30-day youth and adult e-cigarette users. Findings indicate that the wide variety of flavors available and the freedom to “mix-and-match” flavors may maintain use of e-cigarettes among youth and adults, and future research should focus on the composition of the ENDS liquid/vapor to disentangle the contributions of sweeteners and flavorants.
Introduction Coronavirus Disease 2019 (COVID-19) is a public health crisis, but its effects on tobacco users remain ill-defined. This report aimed to assess the relationship between tobacco product-specific risk perceptions for COVID-19 and changes in tobacco use since the start of the pandemic. Methods A sample (n=776) of past-30 day exclusive smokers (n=238), exclusive e-cigarette users (n=143), and dual users (n=395) residing in the US and aged 18 or older was collected using Mechanical Turk from April 27 to June 8, 2020. Adjusted associations between tobacco product-specific COVID-19 risk perceptions (i.e. risk that smokers/vapers are at for COVID-19 relative to non-smokers/non-vapers) and changes in tobacco use since the pandemic began were assessed using partial proportional odds models. Results A majority of those who used cigarettes (63.7%) and e-cigarettes (56.1%) felt that the risk of COVID-19 was greater for users of their tobacco product than for non-users. Twenty-four percent of smokers had increased their cigarette use since the start of the pandemic and 28.0% had decreased. Similarly, 27.3% of e-cigarette users had increased their e-cigarette use since the start of the pandemic and 23.8% had decreased. Higher risk perceptions for COVID-19 were associated with reductions in tobacco use since the pandemic began for exclusive e-cigarette users and dual users. Conclusions These findings provide support that tobacco product-specific COVID-19 risk perceptions may be an important correlate of changes in tobacco use during the pandemic. Targeted information to inform tobacco users regarding their risks for COVID-19 is needed during this public health crisis.
Declines in cigarette smoking prevalence in many countries and the consolidation of the tobacco industry have prompted the introduction of other forms of nicotine delivery. These include electronic nicotine delivery systems (ENDS), heated tobacco products (HTPs) and oral nicotine products (ONPs). Evolving over time, some of these products now deliver nicotine at levels comparable to cigarettes and may serve as effective substitutes for smokers. However, certain products, especially ENDS like JUUL, have also appealed to youth and non-smokers, prompting concerns about expanding nicotine use (and potentially nicotine addiction). The tobacco industry could shift away from primarily promoting cigarettes to promoting ENDS, HTPs and/or ONPs, though at this time it continues to heavily promote cigarettes in low and middle-income countries. Differing regulatory regimes may place upward and downward pressures on both cigarettes and these newer products in terms of population use, and may ultimately drive the extent to which cigarettes are or are not displaced by ENDS, HTPs and/or ONPs in the coming decade.
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