Flavor and Nicotine Effects on E-cigarette Appeal in Young Adults: Moderation by Reason for Vaping

Abstract

Objectives: Effective regulations that reduce nicotine vaping among young adult dual (combustible and e-cigarette) users may differ depending on whether e-cigarettes are used for helping with smoking cessation. This laboratory experiment examined flavor and nicotine effects on e-cigarette product appeal among young adult dual users, stratified by reported use of e-cigarettes to quit smoking. Methods: Dual users aged 18-35 years that did (N = 31) or did not (N = 22) report vaping for the purpose of quitting smoking puffed e-cigarette solutions varied by a flavor (fruit, menthol, tobacco) and nicotine (nicotine-containing [6 mg/mL], nicotine-free) with-in-participant design. After puffing each solution, participants rated appeal. Results: In main effect analyses, non-tobacco (vs tobacco) flavors increased appeal and nicotine-containing (vs nicotine free) solutions reduced appeal similarly in dual users who did and did not vape to quit smoking. Interaction analyses found non-significant trend evidence that fruit and menthol flavors suppressed nicotine's appeal-reducing effects more powerfully in those that did not vape to quit smoking (flavor × nicotine × vape to quit smoking, ps = .05-.06). Conclusions: Non-tobacco flavors might increase e-cigarette product appeal in young adult dual users overall and disproportionately suppress nicotine's appeal-reducing effects in those that vape for purposes other than assisting with smoking cessation.

Appeal, subjective effects, and relative reinforcing effects of JUUL that vary in flavor and nicotine content.

“…Participants in the Flavor Study also earned a significantly greater proportion of puffs from their preferred-flavor pod than from the non-preferred tobacco-flavored pod, despite the escalating amount of effort required to earn puffs from the preferred pod. Given the apparent appealing and reinforcing nature of preferred-flavor pods, coupled with the observed dislike of the tobacco-flavored pods, it is possible that regulations that would restrict the available ENDS flavors may result in increased effort expenditure to obtain illicit flavored ENDS products or non-JUUL ends (e.g., disposables such as Puff Bar) and/or result in the use of other tobacco products such as combusted cigarettes (Leventhal et al, 2020; Pacek, Wiley, et al, 2019), which have a significantly greater relative risk profile (Goniewicz et al, 2018).…”

“…such as liking and willingness to use again compared to non-sweet (e.g., tobacco) and flavorless e-liquids (Goldenson et al, 2016). Recent research also indicates that limiting the availability of ENDS e-liquid flavors results in decreased appeal of ENDS (Leventhal et al, 2020), as well as decreased intended use of and hypothetical choices for ENDS among samples of people who smoke cigarettes (Buckell et al, 2018) and people who are dual users of both ENDS and cigarettes (Pacek, Rass, et al, 2019).…”

“…The availability of flavors is viewed as an appealing characteristic of ENDS products among both youth/adolescents (Ambrose et al, 2015; Kong et al, 2015; Tsai et al, 2018) and adults (Cheney et al, 2016; Evans et al, 2020; Leventhal et al, 2020; McDonald & Ling, 2015; Patel et al, 2016; Sussman et al, 2014) who use ENDS. The appeal of flavored ENDS is evident among young adults, in particular: A qualitative study of young adults reported that being able to consume a wide variety of e-liquid flavors is a motivation for using ENDS (Cooper et al, 2016).…”

“…Moreover, laboratory studies of the impact of e-liquid flavors on subjective appeal among young adults have also indicated that flavored e-liquids—and sweet-flavored e-liquids, in particular—resulted in greater appeal ratings (Audrain-McGovern et al, 2016) such as liking and willingness to use again compared to non-sweet (e.g., tobacco) and flavorless e-liquids (Goldenson et al, 2016). Recent research also indicates that limiting the availability of ENDS e-liquid flavors results in decreased appeal of ENDS (Leventhal et al, 2020), as well as decreased intended use of and hypothetical choices for ENDS among samples of people who smoke cigarettes (Buckell et al, 2018) and people who are dual users of both ENDS and cigarettes (Pacek, Rass, et al, 2019).…”

“…Conversely, in a randomized double-blind crossover design study, Meier and colleagues (Meier et al, 2017) found no differences in terms of withdrawal, satisfaction, intention to quit or confidence to quit using cigarettes, or carbon monoxide or urinary cotinine between users of nicotine-containing versus nicotine-free ENDS. Also, Leventhal and colleagues (Leventhal et al, 2020) found that acute use of nicotine-containing e-liquids in a laboratory-based paradigm actually decreased appeal of ENDS among people who are dual users of both ENDS and cigarettes. These mixed findings potentially suggest that factors in addition to nicotine content alone (e.g., sensory components of vaping, interactive effects between flavor and nicotine content; Krishnan-Sarin et al, 2017; Rosbrook & Green, 2016) are responsible for the appeal of nicotine-containing ENDS products.…”