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E-cigarette flavoring associated with higher self-perceived addiction, satisfaction

People who use flavored electronic cigarettes report higher satisfaction and self-perceived addiction than users of nonflavored e-cigarettes, according to a recent online quantitative survey.

“The connection between flavor use and both satisfaction and perceived addiction suggests that flavor is an integral part of the vaping experience for many e-cigarette users,” researchers from the Tobacco Center for Regulatory Science of the American Heart Association wrote. “These findings may provide direction for the Food and Drug Administration’s plans to restrict flavors other than menthol, mint and tobacco flavors.”

Researchers examined responses from 1,492 current e-cigarette users aged at least 18 years, with current use defined as having vaped in the past week, vaped for 6 months or longer and vaped at least 20 times in their life. Data were collected via an online panel through a marketing research vendor in summer 2016, with two participants excluded due to an inconsistency in reporting race and ethnicity. Demographic variables included race, sex, ethnicity, education, age, annual household income and employment status.

Respondents were asked, “What was the primary reason you started using your vaping device?” and given 15 selectable answers and a write-in option. Flavor preference was determined by responses to the question, “What is the e-liquid flavor you typically buy?” with participants given a list of six flavors and a write-in option. Preferences were then collapsed into six categories: tobacco, mint/menthol, fruit, candy, sweet or coffee/chocolate. Respondents also rated vaping satisfaction on a scale of 1 to 10 and answered the question, “Do you believe you are addicted to or dependent upon vaping?” with response options of no, slightly, somewhat and very much.

Overall, 29.5% of respondents indicated flavor was a primary reason for vaping initiation. Age was found to be a significant predictor of vaping initiation due to flavor. E-cigarette users aged 35 to 44 years were less likely than users aged 18 to 24 years to cite flavor as the primary reason for vaping initiation (OR = 0.53; 95% CI, 0.35-0.8). Nearly two-thirds of respondents reported buying flavored e-liquid (62.9%) other than tobacco flavor, of which the most popular was fruit (42.2%).

When compared with respondents who did not use flavored e-liquid, respondents who used flavored e-liquid, excluding tobacco flavor (OR = 2.73; 95% CI, 1.91-3.89), and respondents who used tobacco-flavored e-liquid (OR = 2.46; 95% CI, 1.65-3.67) were more likely to report high satisfaction with vaping. Past cigarette smokers were also significantly more likely to report high satisfaction with vaping compared with respondents who had never smoked cigarettes (OR = 1.64; 95% CI, 1.22-2.21). Similarly, respondents who used flavored e-liquid other than tobacco flavor had higher odds of perceived addiction compared with those who did not use flavored e-liquid (OR = 2.23; 95% CI, 1.6-3.11).

“Banning fruit and candy avors in particular may decrease vaping initiation, while retaining tobacco, mint and menthol avors may facilitate the maintenance of vaping in adults who may be attracted to e-cigarettes as an alternative to cigarettes or cessation strategy,” the researchers wrote. “Additional research, particularly of a longitudinal nature, is needed to better understand the influence of e-cigarette flavors in initiation and continued use.” – by Eamon Dreisbach

Disclosures: The authors report no relevant financial disclosures.