Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey

Abstract

Background: A major characteristic of the electronic cigarette (EC) market is the availability of a large number of different flavours. This has been criticised by the public health authorities, some of whom believe that diverse flavours will attract young users and that ECs are a gateway to smoking. At the same time, several reports in the news media mention that the main purpose of flavour marketing is to attract youngsters. The importance of flavourings and their patterns of use by EC consumers have not been adequately evaluated, therefore, the purpose of this survey was to examine and understand the impact of flavourings in the EC experience of dedicated users. Methods: A questionnaire was prepared and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 4,618 participants were included in the analysis, with 4,515 reporting current smoking status. The vast majority (91.1%) were former smokers, while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. Both subgroups had a median smoking history of 22 years and had been using ECs for 12 months. On average they were using three different types of liquid flavours on a regular basis, with former smokers switching between flavours more frequently compared to current smokers; 69.2% of the former subgroup reported doing so on a daily basis or within the day. Fruit flavours were more popular at the time of participation, while tobacco flavours were more popular at initiation of EC use. On a scale from 1 (not at all important) to 5 (extremely important) participants answered that variability of flavours was “very important” (score = 4) in their effort to reduce or quit smoking. The majority reported that restricting variability will make ECs less enjoyable and more boring, while 48.5% mentioned that it would increase craving for cigarettes and 39.7% said that it would have been less likely for them to reduce or quit smoking. The number of flavours used was independently associated with smoking cessation. Conclusions: The results of this survey of dedicated users indicate that flavours are marketed in order to satisfy vapers’ demand. They appear to contribute to both perceived pleasure and the effort to reduce cigarette consumption or quit smoking. Due to the fact that adoption of ECs by youngsters is currently minimal, it seems that implementing regulatory restrictions to flavours could cause harm to current vapers while no public health benefits would be observed in youngsters. Therefore, flavours variability should be maintained; any potential future risk for youngsters being attracted to ECs can be sufficiently minimized by strictly prohibiting EC sales in this population group.

Effects of User Puff Topography, Device Voltage, and Liquid Nicotine Concentration on Electronic Cigarette Nicotine Yield: Measurements and Model Predictions

“…In terms of understanding ECIG use, previous reports suggest that experienced ECIG users take longer duration puffs than do cigarette smokers smoking cigarettes 27 or using ECIGs for the first time. 6 The current results help to explain these findings, as longer puffs lead to greater nicotine yield in ECIG aerosol. The fact that puff velocity does not influence nicotine yield may explain why ECIG user puff topography is associated with velocities that are less than those of cigarette smokers.…”

“…Puff durations were chosen to approximate that of a typical cigarette smoker (2 s), 6,27 an experienced ECIG user taking an average length puff (4 s), 6,27 and an experienced ECIG user taking a puff of the more extreme length observed (8 s). 27 Puff velocity was chosen to approximate that observed in tobacco cigarette smokers (33 ml/s), 18,28,29 but because experienced ECIG users may puff more slowly, 30 we also examined the effects of a lower velocity (17 ml/s).…”

“…Though the mixture exiting the ECIG mouthpiece is commonly referred to as a "vapor," it is more correctly termed an "aerosol mist"-a system of liquid droplets suspended in a gas or gas mixture. 4 The apparent popularity of these products likely is attributable to a variety of factors, including marketing, 5 their availability in appealing flavors, 6,7 perceptions that they are less lethal than tobacco cigarettes, 8 and their ability to deliver nicotine, 9,10 a psychomotor stimulant that supports dependence. 11 Although some commentators speculate that ECIGs promise reduced tobacco-caused disease and death in cigarette smokers, 12,13 others speculate that daily, long-term use of these novel products imperils users with adverse health consequences, including nicotine dependence in individuals who were not nicotine-experienced prior to their ECIG use.…”

Electronic Cigarette Use Prevalence, Associated Factors, and Pattern by Cigarette Smoking Status in the United States From NHANES (National Health and Nutrition Examination Survey) 2013–2014

“…Consequently, initial growth in the prevalence of use of these products was noted among cigarette smokers 3. Over time, however, extensive marketing,4 improvements in design, extensive flavor options,5 and a widespread perception that e‐cigarettes were safer than cigarettes led to their increased popularity, especially among youth6, 7, 8, 9, 10 and those who never smoked tobacco 9, 10. This increasing popularity has raised public health concerns, given the paucity of high‐quality longitudinal evidence on the health effects of e‐cigarette exposure and uncertainly about the data supporting their use as smoking‐cessation devices 1…”

Risks of Attempting to Regulate Nicotine Flux in Electronic Cigarettes

“…Surveys indicate that pleasure could be a potential reason for smokers to choose and maintain long-term EC use. 3,10 This is probably one of the main reasons for the enormous variability of different flavors available in EC liquids, 10 and could explain the variability of devices with different characteristics, design, and properties. The recent development and marketing of atomizers with adjustable airflow probably reflects the different preferences by users, and the effort of manufacturers to create products which can be customized based on self-preference.…”