E-Cigarette Flavors and Frequency of E-Cigarette Use among Adult Dual Users Who Attempt to Quit Cigarette Smoking in the United States: Longitudinal Findings from the PATH Study 2015/16–2016/17

Abstract

Potential mechanisms by which e-cigarette use may relate to combustible cigarette smoking cessation are not well-understood. We used U.S. nationally representative data to prospectively evaluate the relationship between e-cigarette flavor use and frequency of e-cigarette use among adult cigarette/e-cigarette dual users who attempted to quit smoking cigarettes. Analyses used Population Assessment of Tobacco and Health (PATH) Study data from adult dual users (2015/16) who attempted to quit smoking between 2015/16 and 2016/17 (Wave 3-Wave 4, n = 685, including those who did/did not quit by 2016/17). E-cigarette flavor use (usual/last flavor, past 30-day flavor; assessed in 2015/16) was categorized into Only tobacco; Only menthol/mint; Only non-tobacco, non-menthol/mint; and Any combination of tobacco, menthol/mint, other flavor(s). The key outcome, evaluated at follow-up in 2016/17, was frequent e-cigarette use, which was defined as use on 20+ of past 30 days. Logistic regression was used to evaluate associations between e-cigarette flavor use in 2015/16 and frequent e-cigarette use at follow-up in 2016/17. Dual users who attempted to quit smoking had greater odds of frequent e-cigarette use at follow-up when they used only non-tobacco, non-menthol/mint flavor than when they used only tobacco flavor as their regular/last e-cigarette flavor (OR = 1.9, 95% CI: 1.1–3.4); findings were no longer significant when adjusted for factors including e-cigarette device type (AOR = 1.4, 95% CI: 0.7–2.8). Past 30-day e-cigarette flavor use results were generally similar, although frequent e-cigarette use at follow-up was highest among those who used any combination of tobacco, menthol/mint, or other flavors. Findings indicate that e-cigarette flavor use among dual users who attempt to quit smoking may be related to e-cigarette use frequency overall, which may indicate a mechanism underlying findings for e-cigarette use and smoking cessation. Further longitudinal research may help to disentangle how e-cigarette characteristics uniquely impact e-cigarette use frequency and smoking cessation/sustained use.

Associations Between E-cigarette Use and E-cigarette Flavors With Cigarette Smoking Quit Attempts and Quit Success: Evidence From a U.S. Large, Nationally Representative 2018–2019 Survey

“… 26 Other studies have reported an increase in the preference for cigarettes with flavor restrictions on e-cigarettes. 27 , 40 In contrast, Kasza et al 41 found no statistically significant differences in the rates of cigarette smoking quit attempts among dual users as a function of e-cigarette flavor use. Similarly, Meernik et al 42 found that non-menthol and tobacco flavors in e-cigarettes are a primary reason for adult cigarette smokers’ e-cigarette use, but that the role of flavored e-cigarettes on smoking cessation remains unclear.…”

E-Cigarette Characteristics and Cigarette Cessation Among Adults Who Use E-Cigarettes

“…Given the established importance of e-cigarette use frequency in cigarette smoking cessation behaviors, 2 , 3 , 4 it is important to understand associations of e-cigarette flavor types and device types with smoking cessation independent of any association these features may have with e-cigarette use frequency. Indeed, using US nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study, Kasza et al 8 found that e-cigarette flavor and e-cigarette device type were each associated with e-cigarette use frequency among adults who used e-cigarettes and attempted to quit cigarette smoking; those who used sweet flavor e-cigarettes had higher use frequency than those who used tobacco flavor e-cigarettes, and those who used tank-style e-cigarettes had higher use frequency than those who used cartridge or disposable e-cigarettes. If use of sweet flavor, tank device types, or both are associated with greater cigarette cessation than use of other flavor and device types, then e-cigarette use frequency could be the mechanism underlying the association, which could explain why flavor and device type may be important in cigarette cessation.…”

Electronic nicotine delivery systems (ENDS) flavours and devices used by adults before and after the 2020 US FDA ENDS enforcement priority: findings from the 2018 and 2020 US ITC Smoking and Vaping Surveys

“…Research has consistently demonstrated that flavours play a role among adults in ENDS initiation, continued use7 14–17 and facilitating switching from smoking to vaping 14. Adults use a wide range of flavours and commonly use non-tobacco flavoured ENDS 14–19. However, flavour preferences appear to differ by smoking status, where current smokers (dual users who smoke and vape) prefer tobacco flavours and ex-smokers (exclusive vapers) prefer fruit flavours 15 17 19.…”