Changing Patterns of First E-Cigarette Flavor Used and Current Flavors Used by 20,836 Adult Frequent E-Cig Users

Bottom Line: Adult 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.

Tobacco harm reduction products and policies aim to prevent or reduce harm by promoting substitution of combustible tobacco with less hazardous non-combustible sources of nicotine to smokers who are unable or unwilling to quit smoking in response to conventional tobacco control measures. E-cigarettes have rapidly grown in popularity among adults as an alternative to smoking conventional cigarettes and are now the most popular assisted method of quitting smoking in the USA, used in 35% of smokers’ most recent quit attempts.

The ability to inhale e-cigarette vapor aerosol in a vast and growing variety of “characterizing flavors”—a distinguishable taste or aroma, other than the taste or aroma of tobacco—is thought to be a major feature accounting for the appeal of e-cigarettes to adult smokers as an alternative to continuing to smoke cigarettes. Yet concerns have been raised that fruit and sweet e-liquid flavors will attract youth and non-smokers to e-cigarette use, that use of flavored e-cigarettes will habituate youth to the effects of nicotine, and in turn, youth who would otherwise not have smoked in the absence of flavored e-cigarettes will “graduate” to use of more harmful tobacco products, such as cigarettes, that deliver nicotine more efficiently. 

The US Food and Drug Administration (FDA) has identified the role flavors play in understanding the shift from conventional cigarettes as a public health research priority. An 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.

The 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. 

Read the full report here.