Association of Flavored Tobacco Use With Tobacco Initiation and Subsequent Use Among US Youth and Adults, 2013-2015

Villanti, Andrea C.; Johnson, Amanda L.; Glasser, Allison; Rose, Shyanika W.; Ambrose, Bridget K.; Conway, Kevin P.; Cummings, K. Michael; Stanton, Cassandra A.; Edwards, Kathryn C.; Delnevo, Cristine D.; Wackowski, Olivia A; Feirman, Shari P.; Bansal-Travers, Maansi; Bernat, Jennifer K.; Holder-Hayes, Enver; Green, Victoria R.; Silveira, Marushka L.; Hyland, Andrew

doi:10.1001/jamanetworkopen.2019.13804

Cited by 119 publications

(81 citation statements)

References 27 publications

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“…The availability of e-cigarette flavors has also increased rapidly: About 242 new flavors were added to the market each month and more than 7,500 e-cigarettes flavors have become available since 2012 (5). In the PATH (Population Assessment of Tobacco and Health) study, a longitudinal study of tobacco use based on a national representative sample of U.S. population aged 12 years or older, 65% of young adults aged 18-24 years and 50% of adults aged 25 years and older who had ever used e-cigarettes started with flavored e-cigarettes (6). In a 2017 press release, the American Thoracic Society voiced a concern that flavored e-cigarettes were attracting people to initiate e-cigarette use (7,8).…”

mentioning

confidence: 99%

Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users

Du¹,

Bascom²,

Fan³

et al. 2020

Annals ATS

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Rationale: The use of electronic cigarettes (e-cigarettes) has rapidly increased in the United States, and thousands of e-cigarette flavors are available. However, there remains a dearth of evidence on e-cigarette flavor use patterns among older e-cigarette users. Objectives: This longitudinal study examined changes in flavor use patterns in long-term e-cigarette users, assessed self-reported adverse reactions, and evaluated users' anticipated reactions to possible U.S. Food and Drug Administration e-cigarette flavor regulatory scenarios. Methods: The study population was 383 adult participants who completed two online e-cigarette surveys in 2012-2014 (baseline survey) and in 2017-2019 (follow-up survey). In both surveys, participants were asked, "Thinking about your preferred liquid, what is the name of this liquid flavor?" and to list all flavors used in the past 30 days. Flavor preference was classified using the Penn State Three-Step Flavor Classification method. Participants reported adverse events (open-ended description) with the associated flavor. Regulatory scenarios were presented, and participants selected perceived actions from among a list of 15 options. Results: Participants' age averaged 44 6 12 years; 86% were exclusive e-cigarette users, and 13% reported "poly-use" (i.e., e-cigarette and other tobacco product use). E-cigarette flavor preference migration occurred in all demographic groups: only 36-44% maintained a preference for their original flavor. Preference for tobacco and menthol or mint decreased over time (40% baseline vs. 22% follow-up); preference for fruit remained stable (23% baseline and follow-up), but chocolate/candy or other sweets preference significantly increased (16% baseline vs. 29% follow-up), and other flavors increased slightly. Migration to sweet flavors was more noticeable in younger adults (18-45 yr); exclusive e-cigarette users preferred sweet flavors more commonly than poly-users did (31% vs. 19%). Flavor-associated adverse reactions, mainly respiratory irritations, were reported by 26 (6.9%) participants. Nearly 50% of the participants reported that they would "find a way" to buy their preferred flavor or add flavoring agents themselves if nontobacco flavors were banned. Conclusions: Flavor migration toward sweet flavors occurred in long-term e-cigarette users, a trend most pronounced in younger and exclusive e-cigarette users. The anticipated maintenance of access to flavors despite regulation suggests an element of e-cigarette-related dependence that requires further evaluation. This information could help clinicians understand the health impacts of e-cigarette flavors, develop appropriate strategies for smoking cessation, and inform the U.S. Food and Drug Administration to plan future regulation of e-cigarette flavors.

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mentioning

confidence: 99%

Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users

Du¹,

Bascom²,

Fan³

et al. 2020

Annals ATS

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“…As the popularity of vaping has risen, there has been a profusion of novel flavor additives, particularly fruit and candy flavors. Nontobacco flavors appeal more to younger e-cigarette users (7) and are associated with a greater likelihood of initiation and continued use over time (8,9). Many of the chemicals used to create particular flavors contain known toxins, including diacetyl and 2,3-pentanedione (10).…”

Section: Epidemiology Of Vaping and The Evali Epidemicmentioning

confidence: 99%

What are the mechanisms underlying vaping-induced lung injury?

Alexander

Bellinghausen²,

Eakin

2020

Journal of Clinical Investigation

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“…We agree with Perez and Crotty Alexander (1) that, although the ban on flavored nicotine e-cigarette cartridges is a good start in preventing adolescents from getting exposed, menthol should be included. It is one of the most popular flavors among youth, and increases the risk for regular tobacco use and subsequent cigarette smoking (8). The flavoring ban should be extended to all ENDS and other tobacco products.…”

mentioning

confidence: 99%

E-Cigarette, or Vaping, Product Use–associated Lung Injury: A Response to Perez and Crotty Alexander

et al. 2020

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We read with great interest the report by Perez and Crotty Alexander highlighting the harmful effects of electronic nicotine delivery systems (ENDS) (1). The use of ENDS among youth continues to escalate, and e-cigarette, or vaping, product use-associated lung injury (EVALI), became an epidemic in the summer of 2019. As a response to these related public health crises, the U.S. Food and Drug Administration has banned all flavors of e-cigarette cartridges, or pods, except menthol and tobacco (2, 3). Although there are many different substances and product sources being investigated, the Centers for Disease Control and Prevention reported that 82% of hospitalized patients with EVALI were using tetrahydrocannabinol (THC)-containing products and the common compound detected in product samples, and in the bronchoalveolar lavage fluid in most of them, was vitamin E acetate; it was not found in bronchoalveolar lavage fluid in the comparison group (4). Vitamin E acetate is used as an additive in THC-containing products, probably as a diluent or for Author disclosures are available with the text of this letter at www.atsjournals.org.

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Association of Flavored Tobacco Use With Tobacco Initiation and Subsequent Use Among US Youth and Adults, 2013-2015

Cited by 119 publications

References 27 publications

Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users

Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users

What are the mechanisms underlying vaping-induced lung injury?

E-Cigarette, or Vaping, Product Use–associated Lung Injury: A Response to Perez and Crotty Alexander

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