Abstract
Background:
The prevalence of electronic cigarette use has grown over the past decade, with some users reportedly initiating e-cigarette use primarily due to flavors. This study examined the role of flavors in initiation among adult e-cigarette users, as well as the association of flavors with satisfaction and perceived addiction to vaping.
Methods:
The analysis sample consisted of 1,492 current e-cigarette users aged 18 or older, drawn from an online quantitative survey conducted in 2016. Multivariable logistic regression and general linear models were used.
Results:
Most current e-cigarette users (62.9%) typically used flavors other than tobacco (including fruit, mint/menthol, sweet, candy, coffee and other), 24.2% typically used tobacco flavors, and 12.9% typically used non-flavored e-cigarettes. Flavor was a common reason for vaping initiation, selected by 29.5% of the sample. Flavor, particularly fruit flavor, was more likely to motivate young adults 18–24 to initiate vaping compared adults 35–44. Those who used flavors, particularly mint/menthol and flavors other than tobacco flavor, had higher odds of reporting high satisfaction with vaping and had higher odds of perceived addiction to vaping than respondents who did not use flavored e-cigarettes.
Conclusions:
Users of flavored e-cigarettes reported greater satisfaction and self-perceived addiction than users of non-flavored e-cigarettes. The appeal of flavors, particularly among young adults, has implications for regulatory policy regarding the marketing and promotion of flavored products. These findings may provide direction for the Food and Drug Administration’s plans to restrict flavors other than menthol, mint, and tobacco.
Keywords: electronic nicotine delivery systems, flavoring agents, addiction, adults, special populations
1. INTRODUCTION
Awareness and use of electronic cigarettes, or e-cigarettes, has increased significantly since their entry into the U.S. market in 2007.1–3 E-cigarettes typically contain nicotine, propylene glycol, glycerin, humectants to produce an aerosol, flavor additives, and compounds to dissolve flavorants.4,5 An estimated 7,700 e-liquids across 466 brands are available, each with their own concentration and combinations of nicotine and flavorings.6–7 Studies have typically categorized flavors into tobacco, menthol or mint, fruit, candy, other sweet, and coffee.8 Flavor is one of the main reasons adults initially try and continue to use e-cigarettes, although other common reasons are using e-cigarettes as a tool for quitting cigarette use, health reasons, and curiosity.9–15
Most adult e-cigarette users use flavored products, with menthol/mint being the most common, followed by fruit.16–17 The appeal of flavor differs by age among adult e-cigarette users. Young adults are more likely to cite flavors as a reason to use c-cigarettes compared with adults aged 55 or older.11–12 Adults age 30 or older are less likely than younger adults (18–29) and youth to prefer sweet flavors and more likely to prefer non-sweet flavors (tobacco, menthol, coffee, spice).17–18 Flavor appears to be associated with use of e-cigarettes as a cessation strategy to quit combustible cigarettes.19–20
Although e-cigarettes are perceived by most adults to be less addictive than combustible cigarettes overall, younger adults indicate higher addictive qualities.21 Compared with non-smokers, cigarette smokers are more likely to believe that e-cigarettes are less addictive than cigarettes.22
A recent review of longitudinal studies provides strong evidence that e-cigarette use is associated with increased odds of subsequent and concurrent cigarette smoking among adolescents and young adults.23 Further, a growing literature suggests that the use of flavored e-cigarettes by youth and young adults may be associated with transitions to other tobacco products.24–25
In summary, available literature suggests the importance of flavors in the vaping experience. To expand our understanding of the role of flavors in e-cigarette use, especially for adults, this study examined the role of flavors in initiation, as well as the association of flavors with satisfaction and perceived addiction to vaping. Our hypothesis was that flavor plays a significant role in the initiation of e-cigarette use, as well as the potential for continued use. We also examined the distinction between tobacco flavor, mint/menthol flavor, and other flavors compared with non-flavored e-liquids.
2. METHODS
2.1. Sample
A national online quantitative survey of 2,561 adults was conducted in summer 2016. Adult participants 18–64 years old were selected randomly from an online panel through a marketing research vendor. Participants in the online panel were recruited via email, online marketing channels, targeted websites, and online affiliate partners, with tailored campaigns for hard-to-reach populations. Individuals were asked about perceptions, and behavior regarding e-cigarettes and other tobacco products as well as socio-demographic information. Specific demographic subgroups were oversampled to ensure sample diversity (non-Hispanic Blacks, Hispanics, lower socioeconomic status) and thus the final sample was not intended to be representative of the general population.
This paper focused on the sub-sample of 1,492 current e-cigarette users. For the purpose of this analysis, current users were defined as those who had vaped within the past week, vaped for 6 months or longer, and vaped at least 20 times in their lifetime, regardless of their combustible cigarette smoking status. These criteria were identified in order to recruit long-term users who had recently vaped. Of 1,494 eligible participants, two were excluded due to inconsistency in reporting race and ethnicity, resulting in a final sample of 1,492 participants.
2.2. Measures
The survey consisted of closed-end and open-end questions. Demographic variables included sex, race, ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), age (18–24, 25–34, 35–44, 45–64), education (highest grade completed), employment status, and annual household income. To examine initiation related to flavors, respondents were asked, “What was the primary reason you started using your vaping device?” and were given a list of 15 possible reasons and allowed to write in an “other” reason. They were instructed to select up to three reasons. To examine flavor preference, respondents were asked “What is the e-liquid flavor you typically buy?” and were given a list of six commonly available flavor categories and were allowed to write in an “other” flavor. They could choose all that apply or indicate no flavor. Responses were categorized into one of the following six categories: tobacco, mint/menthol, fruit, candy, sweet, or coffee/chocolate. The categories were collapsed for analysis into four groups: tobacco flavor, mint/menthol flavor, other flavors, and non-flavored (no flavors selected). Satisfaction with vaping was assessed using a 0–10 scale, where 0=not at all and 10=very much. Perceived addiction to vaping was assessed by asking, “Do you believe you are addicted to or dependent upon vaping?” with four response options, which were ultimately collapsed into two categories for analysis: 1) addicted = “very much,” “somewhat,” “slightly,” and 2) not addicted = “no.”
2.3. Statistical Analyses
Descriptive statistics for e-cigarette users by flavor category were used to compare differences in proportions using a Chi-square test. We used logistic regression models to examine factors associated with “like[d] flavors” as the primary reason for initiating e-cigarette use, as well as to estimate odds ratios of being addicted to vaping by flavored category. We used general linear models to estimate adjusted means of vaping satisfaction level across flavored categories. We also used logistic regression models to further examine the odds of reported vaping satisfaction, where the scale of satisfaction was further categorized as a binary variable: high satisfaction (scale rating of 9 or 10) versus low satisfaction (scale ratings ranged from 0–8). All models were adjusted for sex, age, race, ethnicity, education, employment status, annual household income, cigarette smoking status, and other tobacco product use. Because racial disparity and tobacco/nicotine products use is also an issue that can be addressed from our oversampled Hispanic and non-Hispanic Blacks, we further explored racial differences on the odds of being addicted to vaping as well as of vaping satisfaction, with non-Hispanic White as the reference group in the models. Analyses were conducted with SAS statistical software (version 9.4 with SAS/STAT 14.1, SAS Institute Inc., Cary, NC), and a p value<0.05 was considered statistically significant.
3. RESULTS
3.1. Sample Characteristics
The study participants included 22.9% non-Hispanic Whites, 23.0% non-Hispanic Blacks, and 54.2% Hispanics. Participants were grouped into four age categories: 18–24 (17.5%), 25–34 (38.6%), 35–44 (23.3%), 45+ (20.6%). In terms of cigarette smoking status, 26.4% of respondents had never smoked, 35.6% were past smokers, and 38.0% were current smokers. Nearly half of respondents (43.8%) had used other types of tobacco products. (Table 1)
Table 1.
Demographic information of current e-cigarette users
| N | % | |
|---|---|---|
| 1492 | ||
| Gender | ||
| Female | 770 | 51.6 |
| Race/Ethnicity | ||
| Non-Hispanic White | 341 | 22.9 |
| Non-Hispanic Black | 343 | 23.0 |
| Hispanic | 808 | 54.2 |
| Age | ||
| 18–24 | 261 | 17.5 |
| 25–34 | 576 | 38.6 |
| 35–44 | 348 | 23.3 |
| 45+ | 307 | 20.6 |
| Education | ||
| Less than high school | 63 | 4.2 |
| GED | 64 | 4.3 |
| High school graduate | 238 | 16.0 |
| Some college/2-year associate/trade degree | 610 | 40.9 |
| College degree | 392 | 26.3 |
| Graduate or professional degree | 125 | 8.4 |
| Employment | ||
| Working full-time | 968 | 64.9 |
| Working part-time | 179 | 12.0 |
| Homemaker | 73 | 4.9 |
| Unemployed | 80 | 5.4 |
| Retired | 59 | 4.0 |
| Disabled | 66 | 4.4 |
| Student | 67 | 4.5 |
| HH Income | ||
| Less than $20,000 | 177 | 11.9 |
| $20,000 to $49,999 | 438 | 29.4 |
| $50,000 to $64,999 | 287 | 19.2 |
| $65,000 to $89,999 | 279 | 18.7 |
| $90,000 to $124,999 | 181 | 12.1 |
| $125,000 and over | 130 | 8.7 |
| Flavor Use | ||
| Used tobacco flavored e-cigarettes | 361 | 24.2 |
| Used non-tobacco flavored e-cigarettes | 938 | 62.9 |
| Did not use any flavored e-cigarettes | 193 | 12.9 |
| Cigarette Smoking Status | ||
| Never smoked | 394 | 26.4 |
| Past smoker | 531 | 35.6 |
| Current smoker | 567 | 38.0 |
| Use any Other Tobacco Products | 653 | 43.8 |
3.2. Initiation Due to Flavors
Of the total respondents, 29.5% identified flavor as a primary reason for vaping initiation. Flavor was the third most commonly reported reason for vaping initiation. Other more common reasons were as an alternative to cigarettes (43.7%) and because respondents viewed e-cigarettes as healthier/less harmful than other tobacco products (31.2%). (Table 2) Age, cigarette smoking status, and use of other tobacco products were significant predictors for e-cigarette users initiating due to flavor. For example, the odds of reporting that flavor was a primary reason for vaping in users aged 35–44 were lower by about a half as compared with users aged 18–24 (OR: 0.53, 95% CI: 0.35, 0.80). Users who were either current or past cigarette smokers had lower odds of reporting that flavor was a primary reason for vaping when compared to vapers who never smoked cigarettes; ORs (95% CI) were 0.54 (0.41,0.72) and 0.42 (0.30,0.57) for current and past cigarette smokers, respectively. In contrast, those who were using other tobacco products had higher odds of reporting that flavor was a primary reason for vaping when compared to vapers who did not use other tobacco products; OR (95% CI) was 1.32 (1.03,1.68). There was no racial disparity in reporting that flavor was a primary reason for vaping. (Table 3)
Table 2.
Primary reasons for starting vaping
| N | % | |
|---|---|---|
| 1492 | ||
| Just an alternative to cigarettes | 652 | 43.7 |
| Healthier/less harmful than other tobacco products | 465 | 31.2 |
| I like the flavors | 440 | 29.5 |
| Trying to quit smoking cigarettes or other tobacco products | 277 | 18.6 |
| Nicer smell than tobacco smoke | 276 | 18.5 |
| When I can’t smoke cigarettes | 275 | 18.4 |
| My friends vape | 126 | 8.5 |
| I like trying new products. | 114 | 7.6 |
| Cheaper than other tobacco products | 113 | 7.6 |
| I like the nicotine | 94 | 6.3 |
| More places allow vaping that do not allow smoking | 75 | 5.0 |
| cigarettes or cigars | ||
| Makes me feel good about myself | 70 | 4.7 |
| I’m a cloud chaser – I like big clouds | 69 | 4.6 |
| A healthcare professional recommended it | 54 | 3.6 |
| My family members vape | 32 | 2.1 |
| Other | 38 | 2.55 |
Table 3.
Odds ratios for initiating e-cigarette use due to liking flavors
| OR | 95% CI | P-value | |
|---|---|---|---|
| Sex | |||
| Male (ref) | 1.00 | - | - |
| Female | 0.96 | (0.75, 1.22) | 0.734 |
| Age | |||
| 18–24 (ref) | 1.00 | - | |
| 25–34 | 0.90 | (0.64,1.26) | 0.531 |
| 35–44 | 0.53 | (0.35, 0.80) | 0.002 |
| 45-older | 0.74 | 0.47, 1.17) | 0.204 |
| Race | |||
| Non-Hispanic White/Caucasian (ref) | 1.00 | - | - |
| Non-Hispanic Black/African-American | . 0.95 | (0.65, 1.37) | 0.766 |
| Hispanic | 1.08 | (0.80, 1.51) | 0.631 |
| Highest Grade Level Completed | |||
| Less than high school | 1.65 | (0.80, 3.41) | 0.174 |
| GED | 0.57 | (0.25, 1.30) | 0.182 |
| High school graduate | 1.09 | (0.63, 1.89) | 0.767 |
| Some college/2-year associate/trade degree | 1.33 | (0.82, 2.18) | 0.252 |
| College degree | 1.13 | (0.69, 1.86) | 0.623 |
| Graduate or professional degree (ref) | 1.00 | - | |
| Current Employment Status | |||
| Working full-time (ref) | 1.00 | - | - |
| Working part-time | 1.15 | (0.79, 1.66) | 0.476 |
| Homemaker | 1.40 | (0.81, 2.43) | 0.233 |
| Unemployed | 0.84 | (0.48, 1.47) | 0.546 |
| Retired | 0.64 | (0.29, 1.40) | 0.260 |
| Disabled | 0.88 | (0.45, 1.71) | 0.710 |
| Student | 1.41 | (0.81, 2.47) | 0.229 |
| Total Annual Household Income | |||
| Less than $20,000 (ref) | 1.00 | - | |
| $20,000 to $49,999 | 1.36 | (0.88, 2.08) | 0.162 |
| $50,000 to $64,999 | 1.38 | (0.86, 2.21) | 0.181 |
| $65,000 to $89,999 | 1.43 | 0.88, 2.32) | 0.154 |
| $90,000 to $124,999 | 1.71 | (1.00, 2.90) | 0.049 |
| $125,000 and over | 1.27 | (0.69, 2.35) | 0.439 |
| Cigarette Smoking Status | |||
| Never smoked (ref) | 1.00 | ||
| Current smoker | 0.54 | (0.41, 0.72) | <0.001 |
| Past smoker | 0.42 | (0.30, 0.57) | <0.001 |
| Use other tobacco products | 1.32 | (1.03, 1.68) | 0.028 |
Adjusted for sex, age, race, ethnicity, education, employment status, annual household income, cigarette status, and other tobacco products use.
3.3. E-liquid Flavor Preferences.
Most e-cigarette users (62.9%) reported buying flavored e-liquid other than tobacco flavor. These flavors included fruit (42.2%), mint/menthol (29.3%), sweet (29.2%), candy (24.3%), coffee (12.2%), and other (4.2%). One-fourth of e-cigarette users said they bought tobacco flavored (24.2%) and 12.9% bought non-flavored e-cigarettes. Approximately half (48.2%) indicated buying one flavor versus multiple flavors.
There were 718 participants who purchased only one type of flavor (Table 4). Among those who bought tobacco flavor only, the proportion of respondents 45+ is significantly higher than younger participants (18.0% among 18–24, 16.3% among 25–34, 26.2% among 35–44, 31.3% among 45+, p<0.001). The youngest age group (18–24) was least likely to buy mint/menthol flavors (9.0% among 18–24, 24.8% among 25–34, 20.8% among 35–44, 19.9% among 45+, p=0.02). In contrast, fruit flavors were most likely to be bought by the 18–24 age group (46.1% among 18–24, 28.5% among 25–34, 21.3% among 35–44, 21.0% among 45+, p<0.001). Candy also was bought more often by the 18–24 age group than respondents 25+ (14.6% among 18–24, 8.9% among 25–34, 4.4% among 35–44, 5.1% among 45+, p=0.01).
Table 4.
Flavor typically purchased by age category among those who bought only one flavor (n=718)
| Age Categories | ||||||
|---|---|---|---|---|---|---|
| Flavor (%) | N | 18–24 | 25–34 | 35–44 | 45+ | P-value |
| Tobacco | 163 | 18.0 | 16.3 | 26.2 | 31.3 | <0.001 |
| Mint/menthol | 152 | 9.0 | 24.8 | 20.8 | 22.2 | 0.017 |
| Fruit | 194 | 46.1 | 28.5 | 21.3 | 21.0 | <0.001 |
| Candy | 54 | 14.6 | 8.9 | 4.4 | 5.1 | 0.011 |
| Sweet | 92 | 7.9 | 12.6 | 16.4 | 11.9 | 0.242 |
| Coffee/chocolate | 24 | 0.0 | 3.7 | 4.9 | 2.8 | 0.193 |
| Other | 39 | 4.5 | 5.2 | 6.1 | 5.7 | 0.995 |
P-values based on χ2 test
3.4. Satisfaction with Vaping
Overall, e-cigarette users were satisfied with vaping (adjusted mean 7.90 on an 11-point scale). Satisfaction among those who bought flavored e-liquid was higher than those who did not buy flavored e-liquid. The adjusted mean ratings for flavored e-liquid excluding tobacco flavor, tobacco-flavored e-liquid, and non-flavored e-liquid were 7.83, 7.68, and 6.60, respectively. Results were also consistent when the levels of satisfaction were dichotomized to compare the odds of rating high satisfaction vs. low satisfaction. Odds ratios (95% CI) of rating high satisfaction with vaping among those who bought flavored e-liquid excluding tobacco flavor and tobacco-flavored e-liquid compared to those who did not buy flavored e-liquid were 2.73 (1.91,43.89) and 2.46 (1.65,3.67), respectively. Similarly, the mean rating for mint/menthol-flavored e-liquid was highest, and it was lowest for non-flavored e-liquid. For example, the odds of rating high satisfaction with vaping were 3.23 times higher among those who bought mint/menthol-flavored e-liquid compared to those who did not buy flavored e-liquid (OR: 3.23, 95% CI: 2.20,4.75). (Table 5)
Table 5.
Multivariable linear regression model for satisfaction with vaping in relation to flavors and multivariable logistic regression model for self-perceived addiction to vaping
| Satisfaction with Vaping | ||||
|---|---|---|---|---|
| ORa | 95% CI | P-value | Mean (0–10 scale) |
|
| Uses Flavored E-Cigarettes | ||||
| Yes—Flavors Excluding Tobacco | 2.73 | (1.91, 3.89) | <0.001 | 7.83 |
| Yes—Tobacco Flavor | 2.46 | (1.65, 3.67) | <0.001 | 7.68 |
| No (ref) | 1.00 | - | - | 6.60 |
| Satisfaction with Vaping | ||||
|---|---|---|---|---|
| ORa | 95% CI | P-value | Mean (0–10 scale) | |
| Uses Mint/Menthol E-Cigarettes | ||||
| Yes— Mint/Menthol | 3.23 | (2.20, 4.75) | <0.001 | 8.08 |
| Flavor Excluding Mint/Menthol | 2.41 | (1.68, 3.45) | <0.001 | 7.65 |
| No (ref) | 1.00 | - | - | 6.60 |
| Perceived Addiction to Vaping | |||
|---|---|---|---|
| OR | 95% CI | P-value | |
| Uses Flavored E-Cigarettes | |||
| Yes—Flavors Excluding Tobacco | 2.23 | (1.60, 3.11) | <0.001 |
| Yes—Tobacco Flavor | 3.46 | (2.34, 5.12) | <0.001 |
| No (ref) | 1.00 | - | - |
| Perceived Addiction to Vaping | |||
|---|---|---|---|
| OR | 95% CI | P-value | |
| Uses Mint/Menthol Flavored E-Cigarettes | |||
| Yes—Mint/Menthol | 2.99 | (2.07, 4.33) | <0.001 |
| Flavor Excluding Mint/Menthol | 2.28 | (1.63, 3.19) | <0.001 |
| No (ref) | 1.00 | - | - |
Adjusted for sex, age, race, ethnicity, education, employment status, annual household income, cigarette status, and other tobacco product use.
Odds Ratios of reporting high satisfaction vs. low satisfaction
Adjusted for sex, age, race, ethnicity, education, employment status, annual household income, cigarette status, and other tobacco product use.
Odds Ratios of reporting high satisfaction vs. low satisfaction
Adjusted for sex, age, race, ethnicity, education, employment status, annual household income, and cigarette status
Adjusted for sex, age, race, ethnicity, education, employment status, annual household income, and cigarette status
We also observed differences in satisfaction by age, race, and cigarette smoking status. For example, the odds of rating high satisfaction with vaping in e-cigarette users 45+ were significantly lower than in younger users (18–24) (OR: 0.63, 95% CI: 0.41,0.97). Further, non-Hispanic Black users had significantly higher odds of rating high satisfaction with vaping than non-Hispanic Whites (OR: 1.59, 95% CI: 1.14,2.21). And vapers who were past cigarette smokers had significantly higher odds of rating high satisfaction with vaping than vapers who had never smoked cigarettes (OR: 1.64, 95% CI: 1.22, 2.21). No significant differences between Hispanics and non-Hispanic users were observed. (Table 6)
Table 6.
Multivariable linear regression model for satisfaction with vaping in relation to flavors and multivariable logistic regression model for self-perceived addiction to vaping
| Satisfaction with Vaping | Perceived Addiction to Vaping | |||||
|---|---|---|---|---|---|---|
| OR | 95% CI | P-value | OR | 95% CI | P-value | |
| Age | ||||||
| 18–24 (ref) | 1.00 | - | 1.00 | |||
| 25–34 | 0.88 | (0.63, 1.22) | 0.446 | 1.17 | (0.83, 1.64) | 0.378 |
| 35–44 | 0.78 | (0.54, 1.14) | 0.203 | 1.35 | (0.91, 2.00) | 0.140 |
| 45-older | 0.63 | 0.41, 0.97) | 0.035 | 1.20 | (0.77, 1.87) | 0.414 |
| Race | ||||||
| Non-Hispanic White/Caucasian (ref) | 1.00 | - | - | |||
| Non-Hispanic Black/African-American | 1.59 | (1.14, 2.21) | 0.006 | 1.00 | (0.71, 1.42) | 0.991 |
| Hispanic | 1.32 | (0.98, 1.77) | 0.069 | 1.09 | (0.80, 1.49) | 0.600 |
| Cigarette Smoking Status | ||||||
| Never smoked (ref) | 1.00 | |||||
| Current smoker | 0.78 | (0.59, 1.04) | 0.084 | 0.75 | (0.57, 1.00) | 0.046 |
| Past smoker | 1.64 | (1.22, 2.21) | <0.001 | 1.62 | (1.21, 2.18) | <0.001 |
| Use other tobacco products | 1.16 | (0.92, 1.46) | 0.204 | 1.13 | (0.90, 1.43) | <0.001 |
Adjusted for sex, age, race, ethnicity, education, employment status, annual household income, cigarette status, and other tobacco products use.
3.5. Perceived Addiction
Respondents who bought tobacco-flavored e-liquid had significantly higher odds of reporting perceived addiction to vaping than users who did not buy flavored e-liquid (OR: 3.46, 95% CI: 2.34, 5.12). Similarly, current e-cigarette users reporting purchase of flavored e-liquid other than tobacco flavors had significantly increased odds of reporting perceived addiction compared with users of non-flavored e-liquid (OR: 2.23, 95% CI: 1.60, 3.11). Respondents who bought mint/menthol-flavored e-liquid had significantly higher odds of reporting perceived addiction to vaping than users who did not buy flavored e-liquid (OR: 2.99, 95% CI: 2.07, 4.33). (Table 5) Vapers who were past cigarette smokers had significantly higher odds of reporting perceived addiction than vapers who had never smoked cigarettes (OR: 1.62, 95% CI: 1.21, 2.18). No significant differences were observed by age or race/ethnicity. (Table 6)
DISCUSSION
Our results indicate that the availability of flavors is a key reason for initiating vaping, as reported by adults. Nearly one-third of users indicated starting to vape because they liked the flavors, and flavored products were preferred by most users. These results support findings from previously published research regarding the importance of flavors to the vaping experience.12–13 Our study probed the distinction between tobacco flavor versus other non-tobacco flavors, as well as mint/menthol flavor, and identified some differences. Most e-cigarette users reported buying flavors other than tobacco flavor. Also, users of tobacco-flavored or other flavored e-cigarettes rated their satisfaction with vaping and their perceived addiction to vaping as higher than users who did not use flavored e-liquid. Finally, users of mint/menthol flavored e-liquid reported higher satisfaction and perceived addiction compared with users of non-flavored e-liquid.
We observed significant differences by age group. Flavor, particularly fruit flavor, was more likely to motivate young adults 18–24 to initiate vaping compared adults 25+. The 18–24 age group was more likely to buy fruit or candy flavors and less likely to purchase tobacco or mint flavors, compared with age groups 25+. Overall, these findings strongly suggest flavor is associated with vaping initiation and satisfaction, particularly among younger adults 18–24. The connection between flavor use and both satisfaction and perceived addiction suggests that flavor is an integral part of the vaping experience for many e-cigarette users. Flavors may play a role in vaping initiation as a function of (a) enhanced pleasurable sensory qualities (e.g., taste and smell), (b) those more prone to addiction finding flavoring more appealing, or (c) association of some flavors such as fruit or mint with health or less harm.
4.1. Limitations
There are some limitations of this study. (1) Using an online data collection method, recruitment procedures may have excluded individuals who do not use the Internet; these individuals may differ in important ways from our sample. (2) The survey was cross-sectional, and thus potential changes in perceptions over time were not captured. (3) A non-random sample was recruited to assure adequate representation of specific populations of interest. The researchers were interested in examining potential differences among vulnerable populations, specifically race and ethnicity, for the purposes of this analysis. Thus, our findings cannot be generalized to the larger U.S. population. However, our sample size allowed us to examine differences by key subgroups. (4) Respondents were asked about their purchase of e-liquids rather than use of e-liquids; this may have led to inaccurate interpretation if some respondents were given products and did not buy them directly. (5) We did not inquire about types of devices used, which precluded consideration of device type with flavor preferences and satisfaction. (6) Some measures employed were developed based on related focus group research conducted prior to this survey and, although informed by, were not validated measures. We did not use standardized nicotine dependence questions, but instead measured perception of addiction, which was not a validated measure.
4.2. Conclusions
Users of flavored e-cigarettes report greater satisfaction and perceived addiction than users of non-flavored e-cigarettes. Based on our findings that young adults18–24 are more likely to begin vaping because of flavors and are more satisfied with vaping than adults 45+, the appeal of flavors among young adult users has implications for regulatory policy regarding the marketing and promotion of flavored products. These findings may provide direction for the Food and Drug Administration’s plans to restrict flavors other than menthol, mint, and tobacco flavors. Banning fruit and candy flavors in particular may decrease vaping initiation, while retaining tobacco, mint, and menthol flavors may facilitate the maintenance of vaping in adults who may be attracted to e-cigarettes as an alternative to cigarettes or cessation strategy. Additional research, particularly of a longitudinal nature, is needed to better understand the influence of e-cigarette flavors in initiation and continued use. This study adds to previous research suggesting flavors may serve to promote the initiation and maintenance of e-cigarette use.
Highlights.
Flavor was a reason some users initially tried and continued to use e-cigarettes.
Most e-cigarette users typically used flavors other than tobacco flavor.
Typical flavors included fruit, mint/menthol, sweet, candy, coffee and other.
Satisfaction was greater among users of flavored versus non-flavored e-cigarettes.
Perceived addiction was also greater among users of flavored e-cigarettes.
ACKNOWLEDGMENTS
The authors would like to thank Research Now market research company for collecting the data.
FUNDING
This research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) and the FDA Center for Tobacco Products (CTP) under Awards P50HL120163 and U54HL120163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the Food and Drug Administration, or the American Heart Association.
Footnotes
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All authors declare no conflict of interest.
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