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LATEST STUDY FINDS FLAVORS ARE IMPORTANT FOR ADULT E-CIGARETTE USERS

June 20, 2020

By: Lindsey Stroud

​KEY POINTS:

  • A May, 2020 study published in the journal Annals of the American Thoracic Society inspected flavor preferences in long term users of electronic cigarettes and vapor products.

  • Adult “preference” for traditional tobacco flavors, including tobacco, menthol or mint, “decreased over time.

  • 383 adults participated in the study, completing “two online e-cigarette surveys in 2012-2014 (baseline survey) and in 2017-2019 (follow-up survey).”

  • The average age of participants was 44 years old, 86 percent of participants were “exclusive e-cigarette users,” and 13 percent reported dual use – using an e-cigarette and other tobacco product.

  • The authors noted that “preference for tobacco and menthol or mint decreased over time,” from 40 percent of participants citing using those flavors in 2012-2014 to 22 percent in the follow up study.

  • Use of fruit flavored e-cigarettes remained stable, “but chocolate/candy or other sweets preference significantly increased” from 16 percent of participants in the baseline survey to 29 percent in the 2017-2019 follow-up survey.

  • Only 6.9 percent of participants reported any adverse reactions from flavors.

  • When asked if their preferred flavors were banned, “very few participants anticipated that they would stop using e-cigarettes.” Further, 20.4 percent reported they would find a way to find their preferred flavor.

  • Despite adults use of flavors, policymakers across the country are seeking to ban flavored vapor products. Indeed, four states – including Massachusetts, New Jersey, New York, and Rhode Island – currently ban flavored vapor product sales. Lawmakers in California and Hawaii are currently debating banning flavored vaping devices.

  • Policymakers are prematurely introducing flavor bans to combat youth e-cigarette use, yet youth are not overwhelmingly using vapor products due to flavors.

    • In an analysis of five state surveys on youth e-cigarette use, only 15.6 percent of high school students cited using e-cigarettes because of flavors.

    • A more recent May 2020 “research letter” published in JAMA examined a survey of 1,129 respondents between 14 and 24 years old. Only 4.7 percent of respondents reported “flavors” as a reason for JUUL use, compared to the 62.2 percent of respondents that cited social reasons.

  • Moreover, should lawmakers truly want to address youth tobacco and vapor product use, states should divert more of existing tobacco monies on tobacco control programs, including education and prevention.

  • According to the Centers for Disease Control and Prevention, in 2020, states are estimated to receive $27.2 billion in monies attributable to tobacco taxes and settlement payments. In the same year the states will only allocate $739.7 million – less than 3 percent – to tobacco control programs.

A May, 2020 study published in the journal Annals of the American Thoracic Society inspected flavor preferences in long term users of electronic cigarettes and vapor products, finding that “preference” for traditional tobacco flavors, including tobacco, menthol or mint, “decreased over time” among adult e-cigarette users.

The authors “examined changes in flavor use patterns in long-term e-cigarette users, assessed self-reported adverse reactions, and evaluated users’ anticipated reactions” to possible regulations from the U.S. Food and Drug Administration (FDA).

383 adults participated in the study, completing “two online e-cigarette surveys in 2012-2014 (baseline survey) and in 2017-2019 (follow-up survey).” The average age of participants was 44 years old, 86 percent of participants were “exclusive e-cigarette users,” and 13 percent reported dual use – using an e-cigarette and other tobacco product. According to the authors, “flavor preference migration occurred in all groups: only 36-44% maintained a preference for their original flavor.”

The authors noted that “preference for tobacco and menthol or mint decreased over time,” from 40 percent of participants citing using those flavors in 2012-2014 to 22 percent in the follow up survey. Use of fruit flavored e-cigarettes remained stable, “but chocolate/candy or other sweets preference significantly increased” from 16 percent of participants in the baseline survey to 29 percent in the 2017-2019 follow-up survey. The authors note that “exclusive e-cigarette users preferred sweet flavors more commonly than” dual users.

Only 6.9 percent of participants reported any adverse reactions from flavors in e-cigarettes. This is significant as in late 2019, a spat of vaping-related lung illnesses occurred across the United States. Overwhelming, these illnesses were linked to the use of illicit vapor products containing tetrahydrocannabinol (THC), not legal, regulated products containing nicotine and flavorings.

When inquired about possible regulations by FDA, 42.5 percent of survey respondents “believed that the FDA should regulate e-cigarettes.” When asked what they would do should their preferred flavors be banned, “very few participants anticipated that they would stop using e-cigarettes.” Further, 20.4 percent reported they would find a way to find their preferred flavor.

The study adds to the growing literature that adults rely on flavors in e-cigarettes to quit smoking combustible cigarettes. For example, a 2018 survey of nearly 70,000 American adult vapers “found flavors play a vital role in the use of electronic cigarettes and vaping devices.” Moreover, 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively, “at least some of the time.”

Despite adults use of flavors, policymakers across the country are seeking to ban flavored vapor products. Indeed, four states – including Massachusetts, New Jersey, New York, and Rhode Island – currently ban flavored vapor product sales. Lawmakers in California and Hawaii are currently debating banning flavored vaping devices.

Policymakers are prematurely introducing flavor bans to combat youth e-cigarette use, yet youth are not overwhelmingly using vapor products due to flavors. For example, in an analysis of five state surveys on youth e-cigarette use, only 15.6 percent of high school students cited using e-cigarettes because of flavors. These findings are similar to an analysis of the 2019 National Youth Tobacco survey, which found only 22.4 percent of middle and high school students cited flavors as a primary reason for e-cigarette use, whereas 55.3 percent reported curiosity and 30.8 percent claimed to use an e-cigarette because a “friend or family member used them.”

A more recent May 2020 “research letter” published in JAMA examined a survey of 1,129 respondents between 14 and 24 years old. Only 4.7 percent of respondents reported “flavors” as a reason for JUUL use, compared to the 62.2 percent of respondents that cited social reasons.

Further, flavor bans will stunt a growing billion-dollar industry. According to the Vapor Technology Association, in 2018, the vapor industry created 87,581 direct-vaping related jobs, which generated more than $3.2 billion in wages alone. Moreover, the industry has created thousands of secondary jobs in the United States, bringing the industry’s total economic impact in 2018 to $24,457,512,300. In the same year, the industry provided more than $4.9 billion in taxes. In 2016, 78 percent of e-liquid sales were flavored, and 69 percent of disposable vapor product sales were flavored and menthol products.

Moreover, should lawmakers truly want to address youth tobacco and vapor product use, states should divert more of existing tobacco monies on tobacco control programs, including education and prevention. For example, according to the Centers for Disease Control and Prevention, in 2020, states are estimated to receive $27.2 billion in monies attributable to tobacco taxes and settlement payments. In the same year the states will only allocate $739.7 million – less than 3 percent – to tobacco control programs.

Evidence continues to indicate that adults rely on flavors in e-cigarette products to quit smoking. Rather than eliminating tobacco harm reduction options for adult smokers, lawmakers should divert additional funding to programs that can help smokers quit.

 

Nothing in this analysis is intended to is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101. For more information on tobacco and vapor products, please visit https://www.thr101.org.

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©2020 by Tobacco Harm Reduction 101.