As much as concerned adults like to blame fruit- and candy-flavored e-cigarettes, it’s hard to pin down what drives teens to vape in record numbers. Is it really the sweet-smelling vapor that makes e-cigarettes so irresistible? A study published Tuesday in Public Health Reports goes a long way toward answering that question.
In this new analysis, a team of researchers used data gathered from adolescents (ages 12 to 17), young adults (18 to 24), and older adults to investigate the much-discussed connection between sweet flavors and youth vaping. Out of these 3,086 individuals, adolescents and young adults reported that they were far more likely to prefer candy- and fruit-flavored vape juices.
The researchers, led by Samir Soneji, Ph.D., a demographer at the Dartmouth Institute for Health Policy and Clinical Practice, report that adolescents or young adults were 3.35 times as likely as older adults to use fruit-flavored e-cigarette liquid. The odds of someone in these age groups using a candy-flavored vape juice were even higher: 3.81 times those for adults.
“Teens in record numbers are vaping, and we wanted to know what they’re vaping,” he tells Inverse. “Youth prefer candy- and fruit-flavored e-cigarettes, and the adults — many of whom are smokers — differentially prefer tobacco flavored e-cigarettes. Youth preference really is different.”
Teens and adolescents in Soneji’s study also reported using a higher variety of flavors when they vaped. But out of those adolescents and young adults who stuck with one flavor, fruit flavors were still the most common. For adults who stuck with one flavor, “tobacco or other flavors” were the most common choice.
When it comes to the FDA’s efforts to crack down on vape companies, former FDA commissioner Scott Gottlieb has particularly attacked companies for marketing to teens. In November, e-cigarette maker Juul actually shut down some of its social media accounts (Facebook and Instagram, but not twitter), trying to dispel allegations that they target adolescents with their marketing — not to mention the company’s cucumber, mango, and mint flavors. But flavors themselves still remain contentious, and in November, Juul also removed some of these fruity flavors from stores following a CDC report on the company’s skyrocketing sales. Juul has repeatedly released statements showing that it doesn’t encourage teen use of its products.
This latest paper goes a long way to show that teens actually do prefer those flavors, but then takes it one step further.
When Soneji’s team investigated survey data that showed why teens choose to vape, he noted that the flavors were a key factor in that decision. 77.9 percent of adolescent users and 90.3 percent of young adult users reported that they vape because it comes in flavors that they like. The majority of older adults (79 percent), on the other hand, reported that the main reason they vaped was that they believe it’s safer than traditional cigarettes. Beliefs about safety were the second and third most commonly cited reasons for vaping amongst teens and young adults respectively.
Taken together, these results speak to a key debate in the world of e-cigarette regulation: the tension between helping adults quit smoking and getting a whole new generation of kids hooked on nicotine. Soneji adds that he believes his data show a way the FDA can move forward as it addresses the “epidemic” of teen vaping without limiting options for adult smokers who want to quit.
“It’s well within the FDA’s regulatory authority to ban certain flavors. So it can effectively ban the sale of fruit- and candy-flavored e-cigarettes,” he says. “The e-cigarette industry would be up in arms, saying that doing so you would harm adult tobacco users who are using e-cigarettes to quit, but empirically, scientifically, that’s not the case. You could ban fruit- and candy-flavored e-cigarettes and not harm adult smokers who are using e-cigs to help quit.”
If Gottlieb were still the head of the FDA, this might have been a key weapon in his war on e-cigarettes. Now, it could become a tool for his successor to wield as future regulations are drafted.
Objectives: The use of flavored electronic cigarettes (e-cigarettes) is common among e-cigarette users, but little is known about the potential harms of flavorings, the extent to which the concurrent use of multiple flavor types occurs, and the correlates of flavor type use. The objective of this study was to assess the types of e-cigarette flavors used by adolescent (aged 12-17), young adult (aged 18-24), and older adult (aged 25) e-cigarette users.
Methods: We assessed the prevalence of flavored e-cigarette use within the past month by flavor types and concurrent use of multiple flavor types among past-month e-cigarette users sampled during Wave 2 (2014-2015) of the Population Assessment for Tobacco and Health Study among 414 adolescents, 961 young adults, and 1711 older adults. We used weighted logistic regression models for the use of fruit-, candy-, mint/menthol–, tobacco-, or other-flavored e-cigarettes and concurrent use of multiple flavor types. Covariates included demographic characteristics, e-cigarette use frequency, cigarette smoking status, current use of other tobacco products, and reasons for e-cigarette use.
Results: The leading e-cigarette flavor types among adolescents were fruit, candy, and other flavors; among young adults were fruit, candy, and mint/menthol; and among older adults were tobacco or other flavors, fruit, and mint/menthol. Compared with older adults, adolescents and young adults were more likely to use fruit-flavored e-cigarettes (adjusted odds ratio [aOR] 1⁄4 3.35; 95% confidence interval [CI], 2.56-4.38; and aOR 1⁄4 2.31; 95% CI, 1.77-3.01, respectively) and candy-flavored e-cigarettes (aOR 1⁄4 3.81; 95% CI, 2.74-5.28; and aOR 1⁄4 2.95; 95% CI, 2.29-3.80, respectively) and concurrently use multiple flavor types (aOR 1⁄4 4.58; 95% CI, 3.39-6.17; and aOR 1⁄4 2.28; 95% CI, 1.78-2.91, respectively).
Conclusions: Regulation of sweet e-cigarette flavors (eg, fruit and candy) may help reduce the use of e-cigarettes among young persons without substantially burdening adult e-cigarette users.