The role of flavors in vaping initiation and satisfaction among U.S. adults

Landry, Robyn L.; Groom, Allison; Vu, Thanh Huyen T.; Stokes, Andrew; Berry, Kaitlyn M.; Kesh, Anshula; Hart, Joy L.; Walker, Kandi L.; Giachello, Aida L.; Sears, Clara G.; McGlasson, Kathleen L; Tompkins, Lindsay K.; Mattingly, Delvon T.; Robertson, Rose Marie; Payne, Thomas J.

doi:10.1016/j.addbeh.2019.106077

Cited by 95 publications

(69 citation statements)

References 25 publications

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“…As new flavors continue to be added in the marketplace, the changing preference patterns may reflect the current marketing strategies of the e-cigarette manufacturers to promote sweet flavors for the general population (not just limited to adolescents or young adults) or may reflect a user's own experience that using nontobacco-related flavors may constitute a flavor that they can happily use and make them less likely to return to cigarette smoking (9). In addition, in our study, there was a significant increase in the preference for chocolate/candy or other sweet flavors between baseline and follow-up among exclusive e-cigarette users, but no significant change in flavor use was found in poly-users, implying that exclusive e-cigarette users may use certain flavors to maintain their e-cigarette use behaviors (13,19,20).…”

Section: Discussionmentioning

confidence: 45%

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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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Section: Discussionmentioning

confidence: 45%

“…Even in the first wave of the PATH study, only a small sample of exclusive everyday e-cigarette users (N = 156) was identified (18). Also, there is a dearth of evidence on flavor use patterns in relation to long-term e-cigarette use behaviors (13,17,19,20).…”

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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“…E-cig devices were formally targeted to adult smokers attempting to quit smoking; however, e-cigs have quickly gained immense popularity among adolescents and young adults, making these devices the most popular form of tobacco product usage within this demographic [ 1 ]. Moreover, ENDS products are more attractive to youth (< 18 years of age) compared to cigarettes at least in part due to targeted marketing and availability of a substantial assortment of flavored e-liquids [ 3 – 6 ]. According to the Centers for Disease Control and Prevention (CDC), e-cig usage among youth has increased to more than 5 million individuals in the US as of 2019 [ 7 , 8 ], in addition to about 8 million adult users [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cell-specific toxicity of short-term JUUL aerosol exposure to human bronchial epithelial cells and murine macrophages exposed at the air–liquid interface

et al. 2020

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Backgroud JUUL, an electronic nicotine delivery system (ENDS), which first appeared on the US market in 2015, controled more than 75% of the US ENDS sales in 2018. JUUL-type devices are currently the most commonly used form of ENDS among youth in the US. In contrast to free-base nicotine contained in cigarettes and other ENDS, JUUL contains high levels of nicotine salt (35 or 59 mg/mL), whose cellular and molecular effects on lung cells are largely unknown. In the present study, we evaluated the in vitro toxicity of JUUL crème brûlée-flavored aerosols on 2 types of human bronchial epithelial cell lines (BEAS-2B, H292) and a murine macrophage cell line (RAW 264.7). Methods Human lung epithelial cells and murine macrophages were exposed to JUUL crème brûlée-flavored aerosols at the air–liquid interface (ALI) for 1-h followed by a 24-h recovery period. Membrane integrity, cytotoxicity, extracellular release of nitrogen species and reactive oxygen species, cellular morphology and gene expression were assessed. Results Crème brûlée-flavored aerosol contained elevated concentrations of benzoic acid (86.9 μg/puff), a well-established respiratory irritant. In BEAS-2B cells, crème brûlée-flavored aerosol decreased cell viability (≥ 50%) and increased nitric oxide (NO) production (≥ 30%), as well as iNOS gene expression. Crème brûlée-flavored aerosol did not affect the viability of either H292 cells or RAW macrophages, but increased the production of reactive oxygen species (ROS) by ≥ 20% in both cell types. While crème brûlée-flavored aerosol did not alter NO levels in H292 cells, RAW macrophages exposed to crème brûlée-flavored aerosol displayed decreased NO (≥ 50%) and down-regulation of the iNOS gene, possibly due to increased ROS. Additionally, crème brûlée-flavored aerosol dysregulated the expression of several genes related to biotransformation, inflammation and airway remodeling, including CYP1A1, IL-6, and MMP12 in all 3 cell lines. Conclusion Our results indicate that crème brûlée-flavored aerosol causes cell-specific toxicity to lung cells. This study contributes to providing scientific evidence towards regulation of nicotine salt-based products.

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“…It is estimated that several hundred flavoring chemicals are currently used for e-liquid formulations, allowing consumers to choose on the market among several flavors belonging to menthol, tobacco, fruit (i.e., cherry, blueberry, strawberry, apple), sweets (i.e., caramel, vanilla, liquorice, chocolate) categories, to mention the most popular ones [15,16]. Scientific reports on addictive behaviors highlighted the key role of flavors in vaping initiation, especially among young adults, and the resulting addiction along to nicotine [17]. The inclusion of flavoring additives in e-liquids is one of the most debated issues.…”

Section: Flavoring Additivesmentioning

confidence: 99%

“…The remaining 38 e-liquids were declared nicotine-free. Most of the investigated e-liquids were flavored and may be included in the following typical flavor categories: tobacco (48), mint (17), sweets/candy (11), spicy (7), fruits (3), coffee (3), and alcohol (3). Before analysis, all e-liquids were properly stored at room temperature and kept away from direct sunlight, as recommended on the product label.…”

Section: E-liquids Selectionmentioning

confidence: 99%

Chemical Characterization of Electronic Cigarette (e-cigs) Refill Liquids Prior to EU Tobacco Product Directive Adoption: Evaluation of BTEX Contamination by HS-SPME-GC-MS and Identification of Flavoring Additives by GC-MS-O

et al. 2020

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The present study focused on the determination of benzene, toluene, ethylbenzene and xylenes (BTEX) concentration levels in 97 refill liquids for e-cigs selected by the Italian National Institute of Health as representative of the EU market between 2013 and 2015 prior to the implementation of the European Union (EU) Tobacco Product Directive (TPD). Most of the e-liquids investigated (85/97) were affected by BTEX contamination, with few exceptions observed (levels below the limit of quantification (LOQ) of headspace-solid phase micro extraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS) methodology). Across brands, concentration levels ranged from 2.7 to 30,200.0 µg/L for benzene, from 1.9 to 447.8 µg/L for ethylbenzene, from 1.9 to 1,648.4 µg/L for toluene and from 1.7 to 574.2 µg/L for m,p,o-xylenes. The variability observed in BTEX levels is likely to be related to the variability in contamination level of both propylene glycol and glycerol and flavoring additives included. No correlation was found with nicotine content. Moreover, on a limited number of e-liquids, gas chromatography-mass spectrometry-olfactometry (GC-MS-O) analysis was performed, allowing the identification of key flavoring additives responsible of specific flavor notes. Among them, diacetyl is a flavoring additive of concern for potential toxicity when directly inhaled into human airways. The data reported are eligible to be included in the pre-TPD database and may represent a reference for the ongoing evaluation on e-liquids safety and quality under the current EU Legislation.

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The role of flavors in vaping initiation and satisfaction among U.S. adults

Cited by 95 publications

References 25 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

Cell-specific toxicity of short-term JUUL aerosol exposure to human bronchial epithelial cells and murine macrophages exposed at the air–liquid interface

Chemical Characterization of Electronic Cigarette (e-cigs) Refill Liquids Prior to EU Tobacco Product Directive Adoption: Evaluation of BTEX Contamination by HS-SPME-GC-MS and Identification of Flavoring Additives by GC-MS-O

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