Table 2.
Appeal/Risk Perceptions of Flavored E-Cigarettes among Youth and Adults
| Citation | Population | Study Design | Major Findings |
|---|---|---|---|
| Appeal and Risk Perceptions of Flavored E-Cigarettes among Youth | |||
| Ambrose et al. (2015) | 13,651 youth M age (SD) = 14.5 (0.02) |
Cross-Sectional Survey National Study (PATH) | 81.5% of vapers cited appealing flavors as a reason for e-cigarette use |
| Cooper et al. (2016) | 3,907 Youth 5,482 young adults 32.1% 6th graders 34.5% 8th graders 33.4% 10th graders |
Cross-Sectional Survey Texas | Youth who currently used e-cigarettes had higher odds of describing flavored (vs. non-flavored) e-cigarettes as “less harmful” (aOR = 2.84, 95% CI: 1.91, 4.21) |
| Harrell et al. (2017) | 2,483 youth Age 12–17 |
Cross-Sectional Survey Texas | 78% of youth said they would no longer use e-cigarettes if flavorings were not available |
| Harrell et al. (2016) | 3,907 youth Age 12–17 |
Cross-Sectional Survey | 72.9% of vapers used e-cigarettes because they, “Come in flavors I like” Fruit flavors were the most popular (76%), followed by candy/dessert, (57%) and tobacco (13%) |
| Kong et al. (2015) | 5,405 middle, high school and college students MS M age (SD) = 12.2 (0.9) HS M age (SD) = 15.6 (1.2) College M age (SD) = 22.1 (5.5) |
Cross-Sectional Survey Focus Groups | 43.8% of ever-vapers cited the availability of appealing flavorings as a key reason for experimentation with e-cigarettes |
| Krishnan-Sarin et al | 60 adolescent and young adult vapers M age (SD) = 18.8 (.8) |
Laboratory Study | Significant main effect of menthol on appeal (p=0.006), with 3.5% menthol (M=43.4) rated higher than 0% menthol (M=34.3). Significant main effect of menthol on improved taste (p=0.006), with 3.5% menthol (M=18.52) and 0.5% menthol (M=21.40) rated higher than 0% menthol (M=5.07) Significant main effect of menthol on sensory coolness (p<0.0001), perceived coolness increased at each successive increase in menthol concentration |
| Patrick et al. (2016) | 4,066 high school students (8th, 10th, 12th grades) | Cross-Sectional Survey National Study (MTF) | Good taste was the second most common reason for e-cigarette use among ever-vapers (37.2%) Good taste was the most common reason for vaping among frequent users |
| Pepper et al. (2016) | 1,125 adolescents M age (SD) = 15.1 (1.4) 4% smokers 5% vapers |
Experimental Survey | Adolescents stated they were more likely to try menthol-flavored (OR=4.00; p <0.01) candy-flavored OR=4.53; p < 0.01) or fruit-flavored e-cigarettes (OR=6.49, p < 0.001) than tobacco-flavored e-cigarettes Adolescents perceived fruit-flavored e-cigarettes to be less harmful than tobacco-flavored e-cigarettes (p < 0.05) Harm perceptions were partially explained (mediated) the relationship between flavor type and interest in trying e-cigarettes (p < 0.01) |
| Tsai et al. (2018) | 1,061 middle school ever-vapers 2,988 high school ever-vapers |
Cross-Sectional Survey National Study (NYTS) | 31.0% of participants cited the availability of, “flavors such as mint, candy, fruit, or chocolate” as a reason for vaping 41.1% of past 30-day e-cigarette-only users and 46.0%, of dual users used e-cigarettes because, “they are available in flavors, such as mint, candy, fruit, or chocolate” |
| Villanti et al. (2017) | 13,651 youth Age 12–17 |
Cross-Sectional Survey National Study (PATH) | “Comes in flavors that I like” was the most highly ranked reason for e-cigarette use among vapers |
| Wagoner et al. (2016) | 21 adolescents Age 13–17 |
Focus Group | The wide variety of available sweet e-cigarette flavors are appealing Pleasant orosensory (gustatory) sensations are a primary reason for flavored e-cigarette use |
| Appeal of Flavored E-Cigarettes among Adults | |||
| Amato et al. (2016) | 9,301 Adults Age 18+ |
Cross-Sectional Survey Minnesota | Current vapers (vs. former vapers) cited the availability of sweet- and menthol-flavored e-cigarettes as reasons for use |
| Audrain-McGovern et al. (2016) | 32 smokers Age M (SD) = 25.0 (3.0) 56% menthol smokers |
Laboratory study | Sweet-flavored e-cigarettes were rated as more rewarding (p = 0.001) Participants were willing to work harder to earn puffs from a sweet-flavored e-cigarette than flavorless (p < 0.0001) and took more puffs from the sweet-flavored e-cigarettes during ad-lib vaping (IRR = 2.03; p = 0.01) |
| Berg et al. (2014) | 36 smokers Age M (SD) = 36.1 (15.3) |
Longitudinal study | Flavorings are an appealing element of e-cigarettes Flavors differentiate e-cigarettes from other nicotine replacement products The availability of appealing flavors was a commonly cited reason for e-cigarette use |
| Chen et al. (2018) | 12,383 young adults Age 18–34 |
Prospective Survey National Study (PATH) | Participants who perceived e-cigarettes as less harmful than cigarettes were more likely to use flavored e-cigarettes (aOR [95% CI] = 1.59 [1.15–2.19] p = 0.005) |
| Cheney et al. (2016) | 30 young adult vapers Age M (SD) = 25 (3.8) 77% current smokers |
In-Person Interviews | Vapers cite flavored e-cigarettes were a primary attraction and reason for vaping |
| Etter et al. (2011) | 3,587 vapers Age Median (IQR) = 41 (31–50) 70% former smokers |
Online Survey | Tobacco-flavored e-cigarettes were rated as less satisfying than sweet and menthol flavorings (p < 0.01) |
| Farsalinos et al. (2013) | 4,618 adult vapers Age Median (IQR) = 40 (32–49) 91.2% former smokers |
Online Survey | Fruit (69.4%) and sweet (61.4%) flavors were the most commonly used at the time of the survey Tobacco (69.1%) was the most commonly used flavor at initiation |
| Farsalinos et al. (2015) | 7,060 vapers Age Median (IQR) = 38 (30–46) |
Online Survey | 38.6% of vapers listed the variety of flavorings in e-cigarettes as a reason for initiating vaping |
| Goldenson et al. (2016) | 20 young adult vapers Age M (SD) = 26.3 (4.6) 80% smokers |
Laboratory Study | Sweet-flavored solutions produced greater subjective appeal and perceptual sweetness than non-sweet (tobacco and menthol) e-cigarettes (ps < 0.0001). Sensory sweetness was positively associated with appeal across all flavorings (ps < 0.0001) |
| Harrell et al. (2017) | 4,326 young adults Age 18–29 |
Cross-Sectional Survey Texas | 73.5% of young adults said they would no longer use e-cigarettes if flavorings were not available |
| St Helen et al. (2018) | 14 adult vapers Age M (SD) = 32.3 (13.8) |
Laboratory Study | Average puff duration was significantly longer when using a strawberry e-liquid (M [SD] = 3.2 [1.3] s) compared to the tobacco e-liquid M [SD] = (2.8 [1.1] s) |
| Kim et al. (2016) | 35 adult vapers Age 18–65 65% smokers |
Focus group | Flavor is an exciting and fun e-cigarette product feature Favorite flavors included fruits, sweet/dessert and menthol/mint E-cigarette-only Fruit and sweet/dessert flavors reduce the harshness of nicotine The enjoyment of flavored e-cigarettes was associated with use of recent-generation e-cigarette devices (e.g., advanced personal vaporizers, mods) |
| Kim et al. (2016) | 31 e-cigarette users Age M (SD) =33.6 (10.9) 61% smokers |
Laboratory Study | Sweet-flavored solutions produced greater subjective appeal (p < 0.05) Appeal was positively correlated with sensory sweetness and coolness (ps < 0.0001) Appeal was inversely correlated with bitterness (p <0.01) Menthol was significantly cooler than the sweet and tobacco flavorings (p < 0.01) |
| Litt et al. (2016) | 88 smokers Age 18–55 |
Laboratory Study Field Study (cessation trial) | Menthol (32%) was rated as the most appealing flavor followed by cherry (30%) tobacco (24%), chocolate (10%) and flavorless (4%) |
| McDonald et al. (2015) | 87 young adults Age 18–27 32% vapers 66% smokers |
Focus Groups Semi-Structured Interviews | Flavored e-cigarettes are attractive to vapers and non-vapers Flavored e-cigarettes encourage e-cigarette initiation |
| Nonnemaker et al. (2016) | 365 adult vapers Age 19+ |
Cross-Sectional Survey Florida | Among vapers and cigarette smokers, the absence of flavors significantly reduced the price participants were willing to pay for e-cigarettes |
| Pokhrel et al. (2015) | 62 young adults M age (SD) = 25.1 (5.5) |
Focus Group | Flavorings and sensory satisfaction (i.e., pleasant smell and taste) contribute to the appeal of e-cigarettes |
| Rosbrook et al. (2016) | 32 adult smokers Age 18–45 81% menthol-smokers 16%−38% vapers |
Laboratory study | Menthol increased appeal independently of nicotine (p < 0.0001) Menthol increased perceived coolness (p < 0.0001) Menthol reduced airway irritation/harshness produced by nicotine (p < 0.0001) |
| Soule et al. (2016) | 46 adult vapers Age M (SD) = 35.1 (10.6) |
Concept Mapping Mixed-Method | “Increased satisfaction and enjoyment” and “better feel and taste than [combustible] cigarettes” were the two most commonly cited reasons for flavored e-cigarette use Flavored e-cigarette solutions increase sensory satisfaction, mask the aversive taste of nicotine and increase the reward of e-cigarettes |
| Wagoner et al. (2016) | 56 young adults Age 18–25 |
Focus Group | The variety of available flavors are appealing Good smell is a reason for flavored e-cigarette use |
| Yingst et al. (2015) | 4,421 vapers M age (SD) = 40.1 (12.7) |
Online survey | 85.4% described variety of flavor choices as important |
Note. Citations are presented in alphabetical order.
MTF = Monitoring the Future. PATH = Population Assessment of Tobacco and Health Study. NATS = National Adult Tobacco Survey. OR = Odds ratio. aOR = Adjusted odds ratio. Vaper = E-cigarette user. Youth < 18 years of age. Adults ≥ 18 years of age.
Dual user = Concurrent e-cigarette and combustible cigarette user.