Widespread use of flavored e-cigarettes and hookah tobacco in the United States

Abstract

In 2009, the U.S. Food and Drug Administration banned the sale of flavored cigarettes (excluding menthol) in the U.S. However, the sale of flavored e-cigarettes (FE) and flavored hookah tobacco (FHT) is still legal. In this study (conducted in the US in the period from October 2018 to February 2019), we estimated the prevalence of use of FE and FHT across users' sociodemographic characteristics (e.g., age, sex, race/ethnicity) and identified the key characteristics of tobacco users associated with use of FE and FHT. We analyzed the 2014–2015 Tobacco Use Supplement to the Current Population Survey data for current e-cigarette (n = 3691) and hookah tobacco (n = 658) users. Among e-cigarette users, 65.5% used FE; and among hookah tobacco users, 87.3% used FHT. Among e-cigarette users, the prevalence of use of FE was significantly higher for 18–24 year-old than 45+ year-old adults; women than men; Southern than Northeastern residents; and never smokers of regular cigarettes than current smokers of regular cigarettes (all adjusted p's < 0.05). Among hookah tobacco users, the rates of FHT use were significantly higher for women than men, and never smokers of regular cigarettes than current smokers (all adjusted p's < 0.05). Because availability and accessibility of flavored tobacco products may promote tobacco use, revising regulatory guidelines concerning manufacturing and distribution of FE and FHT may help reduce the popularity of emerging tobacco products. Implications Among users of emerging tobacco products such as e-cigarettes and hookah tobacco, use of flavored products is very common. Among e-cigarette users, 66% consumed flavored e-cigarettes; and among users of hookah tobacco, 87% consumed flavored hookah tobacco. Use of flavored products was especially common among users who were young adults, women, or never and former smokers of regular cigarettes. Availability of emerging tobacco products in many different flavors could be a reason for tobacco use initiation and continued use of tobacco after cessation of regular-cigarette smoking.

Options for waterpipe product regulation: A systematic review on product characteristics that affect attractiveness, addictiveness and toxicity of waterpipe use

“…Our systematic review showed that flavor is the main characteristic to attract smokers to start and continue waterpipe smoking, already at a young age [18][19][20] . Increased liking of tobacco flavor stimulates use, resulting in nicotine dependence.…”

“…across age, race/ethnicity, education etc. 20 Besides flavors, studies report other characteristics of WPS products that increase attractiveness such as the price of the tobacco product 21,22 and nicotine content 22 . On average, participants liked waterpipe products with fruity flavors, low prices and labelled with low nicotine content, preferably nicotine-free 22 .…”

Waterpipe smoking and subsequent cigarette and e-cigarette use: a cohort study

“…The obvious characteristic of concern is that cigarettes, e-cigarettes and waterpipe devices all deliver nicotine in doses that could trigger the process of becoming addicted to nicotine. There is also evidence that the flavours in tobacco and e-cigarettes may play a role in continuing use [ 17 ]. Also psychosocial factors such as use and attitudes about waterpipe/cigarette/e-cigarette use in the home and among friends, as well as the perception of positive social interactions among youth may play a role in the gateway process [ 18 ].…”

Factors affecting hookah tobacco smoking among females in the Islamic Republic of Iran: a qualitative study

“…Another reason indicated for the increase in the use of hookah is the appeal of flavoured tobacco, which was also found in American society (35). This type of tobacco is more popular among women of childbearing age, and if this category of tobacco is banned then the use of hookah could be reduced (36).…”