Table 4.
Factors that Moderate the Use of Flavored E-Cigarettes among Youth and Adults
| Citation | Population | Study Design | Major Findings |
|---|---|---|---|
| Differences in Flavored E-Cigarettes Use by Smoking Status | |||
| Berg (2016) | Vapers and Smokers Age 18–34 832 current vapers 468 former vapers 267 never-vapers |
Online survey | Current smokers used menthol-flavored e-cigarettes the most frequently (36.4%), followed by never-smokers (34.7%) and past smokers (22.8%) More current cigarette smokers (27.4%) than never-smokers (6.1%) or former smokers (15.4%) used tobacco flavors |
| Bonhomme et al. (2016) | 3,434 adult vapers Age 18+ |
Cross-sectional Survey National Adult Tobacco Survey (NATS) | Never-smokers (84.8%) had the highest proportion of flavored e-cigarette use, followed by recent former smokers (78.1%), long-term former smokers (70.4%) and current cigarette smokers (63.2%). |
| Chen et al. (2017) | 18,392 youth Age 11–18 |
Cross-Sectional Survey National Study (NYTS) | Flavored e-cigarette use was associated with increased susceptibility to combustible cigarette smoking among non-smoking youth (aOR=3.8; p < 0.0001) |
| Dai et al. (2016) | 2,017 adolescents Past 30-day vapers Age 11–18 |
Cross-Sectional Survey National Study (NYTS) | 60.9% of past 30-day vapers reported using flavored e-cigarettes Flavored e-cigarette use was associated with increased intentions to initiate combustible cigarette use among never-smokers (aOR = 5.7; p < 0.0001) Flavored e-cigarette use was associated with reduced intentions to quit tobacco use among smokers (aOR = 0.6; p = .006) |
| Dawkins et al. (2013) | 1,347 adult vapers Age M (SD) = 43.4 (12.0) |
Online Survey | More combustible cigarette smokers (61%) used tobacco-flavored e-cigarettes than former smokers (51%; p = 0.012) |
| Etter et al. (2011) | 3,587 vapers Age Median (IQR) = 41 (31–50) 70% former smokers |
Online Survey | Current smokers were more likely to use tobacco-flavored e-cigarettes (p < 0.01) |
| Farsalinos et al. (2013) | 4,618 adult vapers Age Median (IQR) = 40 (32–49) |
Online Survey | More current smokers (53.0%) than former smokers (43.1%) used tobacco-flavored e-cigarettes (p<0.001) More former smokers (30.4%) than current smokers (24.1%) initiated e-cigarette use with sweet-flavored e-cigarettes (p=0.009) |
| Harrell et al. (2016) | 5,482 young adults (age 18–29) 6,051 adults nationwide (age ≥ 30) |
Cross-Sectional Survey Texas | Use of tobacco-flavored e-cigarettes was more common among dual users than exclusive e-cigarette users (p < 0.05) |
| Kim et al. (2016) | 35 adult vapers Age 18–65 65% smokers |
Focus Group | E-cigarette-only users (vs. dual users) preferred using fruit or sweet/dessert flavors |
| Krishnan-Sarin et al. (2014) | 3,614 high school students 1,166 middle school students HS M age (SD) = 15.6 (1.2) MS M age (SD) = 12.2 (0.9) |
Cross-Sectional Survey Connecticut | A greater proportion of current smokers (12.2%) preferred tobacco-flavored e-cigarettes than never-smokers (4.7%) A greater proportion of current smokers (62.0%) preferred menthol-flavored e-cigarettes than never-smokers (52.1%) |
| Nonnemaker et al. (2016) | 379 dual users 268 smokers 13 exclusive vapers Age 19+ |
Cross-Sectional Survey Florida | The absence of flavorings reduced the price exclusive vapers (vs. smokers and dual-users) would be willing to pay for e-cigarettes |
| Patel et al. (2016) | 2,295 smokers 153 nonsmokers Age 18+ |
Cross-Sectional Survey Online | Lighter smokers (vs. heavier smokers) expressed a preference for sweet-flavored e-cigarettes |
| Schneller et al. (2018) | 2,123 adult vapers (age 35–54) 415 youth vapers (age 12–17) 80.4% youth between the ages of 15–17 years |
Cross-Sectional Survey National Study (PATH) | Youth (vs. adults) were significantly more likely use fruit-flavored e-cigarettes (OR [95% CI] = 2.11 [1.55, 2.87]) Youth (vs. adults) were significantly less likely to use menthol/mint-flavored e-cigarettes (OR [95% CI] = 0.14 [0.06, 0.32]) Youth (vs. adults) were significantly more likely to report using 1 flavoring compared to tobacco or unflavored e-cigarette (OR [95% CI] = 2.83 [1.99, 4.03]) Youth were more likely to report using 2+ flavorings (OR [95% CI] = 5.26 [3.60, 7.68]) |
| Differences in Flavored E-Cigarettes Use by Age | |||
| Bonhomme et al. (2016) | 3,434 adult vapers Age 18+ |
Cross-sectional Survey National Adult Tobacco Survey (NATS) | Younger age was associated with flavored e-cigarette use 85.2% of 18–24 year olds used flavored e-cigarettes 51.8% of 45–64 year olds used flavored e-cigarettes |
| Chen et al. (2018) | 12,383 young adults Age 18–34 |
Prospective Survey National Study (PATH) | Younger age was associated with flavored e-cigarette use (aOR [95% CI = 1.28, [1.37, 2.41]; p < 0.001) |
| Etter (2016) | 2,807 vapers Age Median (IQR) = 41 (31–50) 80% former smokers 20.6% US residents |
Online Survey | Young adults (vs. older adults) emphasized the ability to experiment with multiple flavors as key reasons for e-cigarette use |
| Harrell et al. (2016) | 3,907 youth (age 12–17) 5,482 young adults (age 18–29) 6,051 adults (age ≥ 30) |
Cross-Sectional Survey Texas | 72.9% of youth cited flavorings as a reason for e-cigarette use 57.4% of young adults cited flavorings as a reason for e-cigarette use 47.5% of older adults used tobacco-flavored e-cigarettes at initiation 21.0% of young adults used tobacco-flavored e-cigarettes at initiation |
| Kim et al. (2016) | 35 adult vapers Age 18–65 65% smokers |
Focus Group | Younger participants (aged 18–34) were more likely to prefer flavored e-cigarettes Older adults (aged 45–65) preferred tobacco-flavored e-cigarettes |
| 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 | High school students (vs. college students) were more likely to cite flavorings as a reason for experimentation with e-cigarettes (47.0% vs. 32.8%; p < 0.001) |
| Patel et al. (2016) | 2,295 smokers 153 nonsmokers Age 18+ |
Cross-Sectional Survey Online | Younger e-cigarette users were more likely to cite flavorings as a reason for use |
| Smith et al. (2016) | 1,443 adult tobacco users Age 18+ |
Telephone Survey | Younger age (i.e., being 18–24 years old) was associated with increased odds of using flavored tobacco products at initiation |
| Villanti et al. (2017) | 23,208 adults (age 25–65+) 9,112 young adults (age 18–24) 13,651 youth (age 12–17) |
Cross-sectional surveyPATH Study | Prevalence of current flavored e-cigarette use was higher among youth (31.2%) than young adults (13.6%) and adults (7.0%) |
| Gender and Race Differences in Flavored E-Cigarette Use | |||
| Baumann et al. (2015) | 944 hospitalized smokers White age: M (SD) = 44.7 (13.2) Black age: M (SD) =46.8 (12.4) 43.0% Black 55.3% male |
Cross-sectional survey | There were race differences in flavored e-cigarette use (p < 0.001) A higher proportion of Blacks (71%) used menthol-flavored e-cigarettes compared to Whites (34%) More Whites (61%) than Blacks (3%) used tobacco-flavored e-cigarettes |
| Chen et al. (2018) | 12,383 young adults (aged 18–34) 50.6% male 72.5% White |
Prospective Survey National Study (PATH) | Female gender was associated with flavored e-cigarette use (aOR [95% CI] = 1.81 [1.33, 2.46]; p < 0.001) Black participants (vs. white) were more less likely to use flavored e-cigarettes (aOR = 0.64 [0.42, 0.99]; p = 0.04) |
| Dawkins et al. (2013) | 1,347 vapers Age M (SD) = 43.4 (12.0) 30% female 96% White |
Online Survey | Males preferred tobacco flavored e-cigarettes (p < 0.001) More females used sweet-flavored e-cigarettes (p < 0.001) |
| Kistler et al. (2017) | 34 vapers Age M (SD) = 41 (18) 56% female 68% White |
Focus group | Females (vs. males) mentioned flavor more often and preferred the variety of flavors |
| Oncken et al. (2016) | 20 adult vapers Age M (SD) = 42.2 (9.7) 45% female 70% White |
Laboratory study | Significant flavor × sex interaction (p < .01) Females (vs. males) rated e-cigarettes as significantly less appealing when using their non-preferred e-cigarette flavor |
| Patrick et al. (2016) | 4,066 high school students (8th, 10th, 12th grades) | Cross-Sectional Survey National Study (MTF) | Significantly more White (38.9%) than Black (31.9%) and Hispanic (29.6%) students reported vaping, “Because it tastes good” |
| Piñeiro et al. (2016) | 1,815 e-cigarette users M age (SD) = 39.82 (13.10) 37.5% age 30–44 33.2% female 92.1% White |
Online survey | Significant sex differences in flavored e-cigarette use (p = 0.009) 81.2 of males used flavored e-cigarettes vs. 86.1% of females 18.8% of males used tobacco-flavored e-cigarettes vs. 13.9% of females |
| Rosbrook et al. (2016) | 32 adult smokers Age 18–45 50% male 81% menthol-smokers 16%−38% vapers |
Laboratory study | Females (vs. males) rated the overall sensory effects of menthol higher in the low menthol condition (0.5% menthol) without nicotine Males (vs. females) rated irritation/harshness higher in the high-menthol (3.5%) low nicotine condition Females (vs. males) rated irritation/harshness lower at the highest nicotine concentration |
Note. Citations are presented in alphabetical order. NYTS = National Youth Tobacco Survey. PATH = Population Assessment of Tobacco and Health Study. NATS = National Adult Tobacco Survey. OR = Odds ratio. aOR = Adjusted odds ratio. Vaper = E-Cigarette user.