Adolescents' interest in trying flavoured e-cigarettes

Abstract

Background More U.S. adolescents use e-cigarettes than smoke cigarettes. Research suggests flavored e-cigarettes appeal to youth, but little is known about perceptions of and reasons for attraction to specific flavors. Methods A national sample of adolescents (n=1,125) ages 13-17 participated in a phone survey from November 2014-June 2015. We randomly assigned adolescents to respond to survey items about 1 of 5 e-cigarette flavors (tobacco, alcohol, menthol, candy, or fruit) and used regression analysis to examine the impact of flavor on interest in trying e-cigarettes and harm beliefs. Results Adolescents were more likely to report interest in trying an e-cigarette offered by a friend if it were flavored like menthol (OR=4.00, 95% CI 1.46-10.97), candy (OR=4.53, 95% CI 1.67-12.31), or fruit (OR=6.49, 95% CI 2.48-17.01) compared to tobacco. Adolescents believed that fruit-flavored e-cigarettes were less harmful to health than tobacco-flavored e-cigarettes (p<.05). Perceived harm mediated the relationship between some flavors and interest in trying e-cigarettes. A minority believed that e-cigarettes did not have nicotine (14.6%) or did not know whether they had nicotine (3.6%); these beliefs did not vary by flavor. Discussion Candy, fruit, and menthol-flavored e-cigarettes appeal to youth more than tobacco or alcohol-flavored, but the appeal is only partially explained by beliefs about reduced harm. Given adolescents’ interest in trying e-cigarettes with certain flavors, policymakers should consider restricting advertisements promoting flavored products in channels that reach large numbers of young people. Future research should examine other reasons for the appeal of individual flavors, such as novelty and perceived prestige.

A fMRI study on the impact of advertising for flavored e-cigarettes on susceptible young adults

“…All e-cigarette advertisements depicted either an e-liquid container or e-cigarette; all cigarette advertisements depicted either a cigarette pack or cigarette. E-cigarette advertisements were for sweet (i.e., candy/desserts) and fruit flavor e-cigarettes, based on evidence of the appeal of these flavors to youth compared with other flavors (Krishnan-Sarin et al, 2015; Pepper et al, 2016; Vasiljevic et al, 2016), and testing only these top flavor preferences also reduced differences in novelty between sweet/fruit and tobacco flavor e-cigarette advertisements; tobacco flavor e-cigarette advertisements depicted tobacco, tobacco plants, leaves or crops. Control images of sweets, fruits, and mint with no tobacco product were taken from online image sources to match the background images of sweet/fruit flavor e-cigarette advertisements and menthol cigarette advertisements.…”

“…Youth were early experimenters who had tried an e-cigarette and were susceptible to future e-cigarette use, based on findings that susceptibility predicts initiation and progression of e-cigarette use (Bold et al, 2016). fMRI was used to test the hypothesis that NAc response would be greater for sweet/fruit versus tobacco flavor e-cigarette advertisements, based on reported preferences for sweet and fruit flavor e-cigarettes as compared with other flavors of e-cigarettes, among youth (Krishnan-Sarin et al, 2015; Pepper et al, 2016; Vasiljevic et al, 2016). Menthol and regular cigarette advertisements and images of fruits and sweets with no tobacco product were used as controls.…”

Compliance with a Sales Policy on Flavored Non-cigarette Tobacco Products

“…5 Flavored tobacco products are viewed favorably by users 6 and are perceived by youth to be less harmful to health than non-flavored products. 7 Furthermore, sales of these products appear be driving the growth of non-cigarette tobacco use among youth, young adults and adults. 8-15 …”

Flavoured tobacco products in the USA: synthesis of recent multidiscipline studies with implications for advancing tobacco regulatory science

“…Pepper et al 21 used a national phone survey in 1125 adolescents aged 13–17 to explore reasons for the appeal of specific e-cigarette flavours. They found that adolescents were more likely to report interest in trying an e-cigarette when offered by a friend if flavoured with menthol, candy or fruit compared with traditional tobacco flavour.…”