Abstract
BackgroundUnderstanding the role that flavors play in the population’s use of e-cigarettes and the impact that flavored e-cigarette products have on the population’s use of more harmful tobacco products, like conventional cigarettes, has been identified by the US Food and Drug Administration (FDA) as a public health research priority. The purpose of the study was to assess the first e-cigarette flavor and current e-cigarette flavors used by a large non-probabilistic sample of adult frequent users of e-cigarettes in the USA and assess how flavor preferences vary by cigarette smoking status and time since first e-cigarette purchase.MethodsAn online survey assessed the first e-cigarette flavor and current e-cigarette flavors used by a non-probabilistic sample of 20,836 adult frequent e-cigarette users in the USA. Differences in e-cigarette flavor preferences between current smokers, former smokers, and never-smokers and trends in the first flavor used across time of e-cigarette use initiation were assessed.ResultsThe majority (n = 15,807; 76.4%) of sampled frequent e-cigarette users had completely substituted e-cigarettes for conventional cigarettes—“switchers”—and were currently using rechargeable, refillable vaping devices. Among them, the proportion of first e-cigarette purchases that were fruit-flavored increased from 17.8% of first purchases made before 2011 to 33.5% of first purchases made between June 2015 and June 2016. Tobacco-flavored first purchases almost halved during this time (46.0% pre-2011 to 24.0% between 2015 and 2016). Fruit/fruit beverage (73.9 to 82.9% of sampled users), dessert/pastry (63.5 to 68.5% of sampled users), and candy, chocolate, or sweets (48.7 to 53.4% of sampled users) were the most popular currently used e-cigarette flavors. Tobacco and menthol flavors, the two most popular flavors for initiating e-cigarette use prior to 2013, now rank as the 5th and 6th most popular currently used e-cigarette flavors, respectively.ConclusionsAdult frequent e-cigarette users in the USA who have completely switched from smoking cigarettes to using e-cigarettes are increasingly likely to have initiated e-cigarette use with non-tobacco flavors and to have transitioned from tobacco to non-tobacco flavors over time. Restricting access to non-tobacco e-cigarette flavors may discourage smokers from attempting to switch to e-cigarettes.
Highlights
Understanding the role that flavors play in the population’s use of e-cigarettes and the impact that flavored e-cigarette products have on the population’s use of more harmful tobacco products, like conventional cigarettes, has been identified by the United States (US) Food and Drug Administration (FDA) as a public health research priority
[8] Under the Food and Drug Administration’s (FDA) final deeming rule, decisions as to whether authorizing marketing orders for flavored e-cigarette products would be appropriate for the protection of the public health must be based on a weighing of the risks and benefits to both users and non-users of tobacco products
Participants After removal of 286 duplicate entries, 758 entries from individuals not living in the USA (Canada n = 289; UK n = 291; country of residence not specified n = 178), and 396 entries from individuals who did not indicate where they found out about the survey, a sample of 22,411 US-based, adult (≥18 years), ever-users of e-cigarettes was retained for preliminary analysis
Summary
Understanding the role that flavors play in the population’s use of e-cigarettes and the impact that flavored e-cigarette products have on the population’s use of more harmful tobacco products, like conventional cigarettes, has been identified by the US Food and Drug Administration (FDA) as a public health research priority. On the other hand, we need to know whether...certain flavors may help adult cigarette smokers switch to potentially less harmful forms of nicotine delivery such as e-cigarettes” [9] To this end, on March 21, 2018, FDA issued an advance notice of proposed rulemaking (ANPRM) to obtain information related to the role that flavors play in the population’s use of tobacco products. On March 21, 2018, FDA issued an advance notice of proposed rulemaking (ANPRM) to obtain information related to the role that flavors play in the population’s use of tobacco products This ANPRM is seeking data, research results, comments, and other information about, among other things, the extent to which certain flavors may attract youth to initiate use of a tobacco product and the extent to which certain flavors may help adult cigarette smokers quit or reduce cigarette use and switch to potentially less harmful products. FDA is seeking this information to inform regulatory actions that FDA might take with respect to flavored tobacco products under the Federal Food, Drug, and Cosmetic Act (“FD&C Act”), as amended by the Tobacco Control Act
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